Individual
TANESHA IVORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4887 W 13TH ST, CLEVELAND, OH 44109-5655
(216) 501-2310
Mailing address
4887 W 13TH ST, CLEVELAND, OH 44109-5655
(216) 501-2310
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
PRS.007756
OH
Other
Enumeration date
05/11/2026
Last updated
05/11/2026
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