Provider Demographics
NPI:1912479569
Name:SWEENY, THERESA ANNE
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:SWEENY
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 1:14623 BAYES AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5917
Mailing Address - Country:US
Mailing Address - Phone:216-816-8884
Mailing Address - Fax:
Practice Address - Street 1:14623 BAYES AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5917
Practice Address - Country:US
Practice Address - Phone:216-816-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant