Provider Demographics
NPI:1912297490
Name:ALDRICH, NELY (MD)
Entity Type:Individual
Prefix:
First Name:NELY
Middle Name:
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 LANDERBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6510
Mailing Address - Country:US
Mailing Address - Phone:440-443-0423
Mailing Address - Fax:440-443-0414
Practice Address - Street 1:5655 HUDSON DR STE 301
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4454
Practice Address - Country:US
Practice Address - Phone:330-653-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35126160207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology