MEDICARE: PATRICE NICOLE UQDAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1689366882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE NICOLE UQDAH

Provider Business Mailing Address
First Line	:	4374 VALLEYSIDE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1048
Country	:	US
Telephone Number	:	216-316-6506
Fax Number	:

Provider Business Practice Location Address
First Line	:	4374 VALLEYSIDE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1048
Country	:	US
Telephone Number	:	216-316-6506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2023
Last Update Date	:	05/24/2023

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Directions to “ PATRICE NICOLE UQDAH ” Practice Location

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