Provider Demographics
NPI:1588411227
Name:LEE, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 SLOANE AVE APT 714
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3160
Mailing Address - Country:US
Mailing Address - Phone:440-654-0224
Mailing Address - Fax:
Practice Address - Street 1:1370 SLOANE AVE APT 714
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3160
Practice Address - Country:US
Practice Address - Phone:440-654-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide