Provider Demographics
NPI:1265136907
Name:WAKEFIELD, TERESA LAFAYE
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LAFAYE
Last Name:WAKEFIELD
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 1:10305 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3461
Mailing Address - Country:US
Mailing Address - Phone:216-772-5450
Mailing Address - Fax:
Practice Address - Street 1:10305 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3461
Practice Address - Country:US
Practice Address - Phone:216-772-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant