Provider Demographics
NPI:1174199533
Name:VEDAA, JUIE MICHELLE
Entity Type:Individual
Prefix:
First Name:JUIE
Middle Name:MICHELLE
Last Name:VEDAA
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 1:1556 MARS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3823
Mailing Address - Country:US
Mailing Address - Phone:216-272-5629
Mailing Address - Fax:
Practice Address - Street 1:1556 MARS AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3823
Practice Address - Country:US
Practice Address - Phone:216-272-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist