Provider Demographics
NPI:1740782143
Name:SHED, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:SHED
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 1:5712 WYNNEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0710
Mailing Address - Country:US
Mailing Address - Phone:440-371-4735
Mailing Address - Fax:
Practice Address - Street 1:1801 SUPERIOR AVE E STE 130
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2135
Practice Address - Country:US
Practice Address - Phone:216-504-3480
Practice Address - Fax:866-608-0504
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator