Provider Demographics
NPI:1306415880
Name:HYNES, AQUILLA MICHELLE
Entity Type:Individual
Prefix:
First Name:AQUILLA
Middle Name:MICHELLE
Last Name:HYNES
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:PO BOX 301001
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-0922
Mailing Address - Country:US
Mailing Address - Phone:440-328-7487
Mailing Address - Fax:
Practice Address - Street 1:18120 PURITAS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-3832
Practice Address - Country:US
Practice Address - Phone:440-796-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide