MEDICARE: KEASIA CANNON

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	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1962382135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEASIA CANNON

Provider Business Mailing Address
First Line	:	5115 E LAKE RD
Second Line	:
City	:	SHEFFIELD LAKE
State	:	OH
Zip	:	44054-1751
Country	:	US
Telephone Number	:	440-670-9569
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 E LAKE RD APT 513
Second Line	:
City	:	SHEFFIELD LAKE
State	:	OH
Zip	:	44054-1736
Country	:	US
Telephone Number	:	440-670-9569
Fax Number	:

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

Provider Enumeration Date	:	09/06/2025
Last Update Date	:	09/06/2025

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Directions to “ KEASIA CANNON ” Practice Location

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