Provider Demographics
NPI:1740026988
Name:MILLER, MODESTY IZRAEYA
Entity type:Individual
Prefix:
First Name:MODESTY
Middle Name:IZRAEYA
Last Name:MILLER
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 1:24538 ROBINIA DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3043
Mailing Address - Country:US
Mailing Address - Phone:980-413-7901
Mailing Address - Fax:
Practice Address - Street 1:24538 ROBINIA DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3043
Practice Address - Country:US
Practice Address - Phone:980-413-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver