Provider Demographics
NPI:1952048241
Name:MCDANIEL, ANISSA RAYELLE
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:RAYELLE
Last Name:MCDANIEL
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 1:4150 STONEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3163
Mailing Address - Country:US
Mailing Address - Phone:216-533-7414
Mailing Address - Fax:
Practice Address - Street 1:4150 STONEHAVEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3163
Practice Address - Country:US
Practice Address - Phone:216-533-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTZ703096171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator