Individual
SHERLY KODIYAN OUSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5592 BROADVIEW RD STE 103, PARMA, OH 44134-1677
(216) 741-5200
Mailing address
13000 AUBURN RD, CHARDON, OH 44024-9337
14402799357
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AG0217016
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02170168
—
OH
01
—
AG0217016
MEDICARE
OH
Enumeration date
08/18/2017
Last updated
08/18/2017
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