Provider Demographics
NPI:1598532244
Name:BYERS, MICHAILA GRACE
Entity Type:Individual
Prefix:
First Name:MICHAILA
Middle Name:GRACE
Last Name:BYERS
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 1:151 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:KARNS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16041-1618
Mailing Address - Country:US
Mailing Address - Phone:724-991-0495
Mailing Address - Fax:
Practice Address - Street 1:2050 EAST 96TH STREET GLICKMAN TOWER
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10357133V00000X
NY86374468133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered