MEDICARE: MRS. ELENA LEAH SIMKHOVICH

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	363L00000X	Nurse Practitioner	APRN.CNP.0040951	OH

General Provider Information

NPI Number	:	1689537318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELENA LEAH SIMKHOVICH

Provider Business Mailing Address
First Line	:	2550 SOM CENTER RD # WH20
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9655
Country	:	US
Telephone Number	:	444-943-2500
Fax Number	:	440-516-8316

Provider Business Practice Location Address
First Line	:	2550 SOM CENTER RD # WH20
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9655
Country	:	US
Telephone Number	:	440-943-2500
Fax Number	:	440-516-8316

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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