Provider Demographics
NPI:1598375313
Name:SCHOFER, BRYN ILISE
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:ILISE
Last Name:SCHOFER
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 1:29201 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1846
Mailing Address - Country:US
Mailing Address - Phone:216-220-8774
Mailing Address - Fax:
Practice Address - Street 1:29201 AURORA RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1846
Practice Address - Country:US
Practice Address - Phone:216-220-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist