Provider Demographics
NPI:1164274866
Name:ENSLEY, ROMESHA
Entity Type:Individual
Prefix:
First Name:ROMESHA
Middle Name:
Last Name:ENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 FIRST PL STE B12
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6703
Mailing Address - Country:US
Mailing Address - Phone:216-536-2163
Mailing Address - Fax:
Practice Address - Street 1:7603 FIRST PL STE B12
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-6703
Practice Address - Country:US
Practice Address - Phone:216-536-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator