Provider Demographics
NPI:1477362093
Name:CERVELLI, MIKALA
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:CERVELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICKEY
Other - Middle Name:
Other - Last Name:CERVELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7649 SYLVAN TOWNE DR APT 334
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9551
Mailing Address - Country:US
Mailing Address - Phone:734-780-6487
Mailing Address - Fax:
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-530-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program