MEDICARE: TYANN SHERRE DANIELS

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	175T00000X	Peer Specialist	APS.004673	OH

General Provider Information

NPI Number	:	1942079967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYANN SHERRE DANIELS

Provider Business Mailing Address
First Line	:	5311 WETZEL AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5366
Country	:	US
Telephone Number	:	234-802-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 WETZEL AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5366
Country	:	US
Telephone Number	:	234-802-2020
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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Directions to “ TYANN SHERRE DANIELS ” Practice Location

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