Provider Demographics
NPI:1912540543
Name:DECESARE, LYNDSEY RACHELLE
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:RACHELLE
Last Name:DECESARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:RACHELLE
Other - Last Name:KYTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 952041
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0051
Mailing Address - Country:US
Mailing Address - Phone:855-449-1540
Mailing Address - Fax:440-672-5068
Practice Address - Street 1:6559 WILSON MILLS RD STE 106
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3433
Practice Address - Country:US
Practice Address - Phone:855-449-1540
Practice Address - Fax:440-672-5068
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025741363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner