Provider Demographics
NPI:1780497297
Name:YISRAEL, AMISHA (DRIVER)
Entity type:Individual
Prefix:
First Name:AMISHA
Middle Name:
Last Name:YISRAEL
Suffix:
Gender:F
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25636 BROOKDALE LN
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1810
Mailing Address - Country:US
Mailing Address - Phone:216-376-9457
Mailing Address - Fax:
Practice Address - Street 1:25636 BROOKDALE LN
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1810
Practice Address - Country:US
Practice Address - Phone:216-376-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS829486172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver