MEDICARE: IYESHA IVEY

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	1831545	OH
2	376J00000X	Homemaker	1831545	OH
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	1831545	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952929465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IYESHA IVEY

Provider Business Mailing Address
First Line	:	33140 AURORA RD STE 202
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-3650
Country	:	US
Telephone Number	:	440-373-9783
Fax Number	:	440-373-9783

Provider Business Practice Location Address
First Line	:	33140 AURORA RD STE 202
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-3650
Country	:	US
Telephone Number	:	440-373-9783
Fax Number	:	440-373-9783

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

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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Directions to “ IYESHA IVEY ” Practice Location

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