Provider Demographics
NPI:1255980827
Name:PITTAWAY, ALEXANDRA
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:
Last Name:PITTAWAY
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 1:8425 CHERRY HILL LANE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-552-3611
Mailing Address - Fax:
Practice Address - Street 1:8425 CHERRY HILL LANE
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147
Practice Address - Country:US
Practice Address - Phone:440-552-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider