Provider Demographics
NPI:1821380635
Name:CHRISTIE, NYSSA ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:NYSSA
Middle Name:ANN
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10421 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9504
Mailing Address - Country:US
Mailing Address - Phone:440-289-3990
Mailing Address - Fax:
Practice Address - Street 1:23250 MERCANTILE RD., SUITE 120
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-591-1600
Practice Address - Fax:216-595-1653
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003707213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist