Provider Demographics
NPI:1588132443
Name:CLAY, SERITA NICOLE I
Entity type:Individual
Prefix:MRS
First Name:SERITA
Middle Name:NICOLE
Last Name:CLAY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SERITA
Other - Middle Name:NICOLE
Other - Last Name:CLAY
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DOULA
Mailing Address - Street 1:4066 STILMORE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2615
Mailing Address - Country:US
Mailing Address - Phone:216-355-4639
Mailing Address - Fax:
Practice Address - Street 1:4066 STILMORE RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2615
Practice Address - Country:US
Practice Address - Phone:216-355-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid