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NPI Code Detail

MEDICARE: SELITA REYNOSO

MEDICARE: SELITA REYNOSO
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
1164W00000XLicensed Practical NurseLPN.186485OH

General Provider Information

NPI Number : 1811822208
Entity Type Code : Individual
Provider Name (Legal Business Name) : SELITA REYNOSO
Provider Business Mailing Address
First Line : 12557 RAVENWOOD DR
Second Line :
City : CHARDON
State : OH
Zip : 44024-9009
Country : US
Telephone Number : 440-285-3568
Fax Number :
Provider Business Practice Location Address
First Line : 2801 C CT
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-4577
Country : US
Telephone Number : 440-998-4210
Fax Number : 440-998-6489
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

Similar Medicare Providers

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Practice Location Address:
2801 C CT
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44004-4577
Practice Phone: 440-998-4210
Practice Fax:
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1962446799 — MR. JAMES W. COZY MA
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1275624116 — MR. ROBERT ALLEN HANSEN M.ED., PCC-S
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1831280619 — MR. TIMOTHY MICHAEL HICKS PCC
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1386730612 — MARTHA JULIA SWICK M.A. PSYCHOLOGY ASST
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Directions to “ SELITA REYNOSO ” Practice Location

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