Provider Demographics
NPI:1629969696
Name:BLACK, YASHEA (PS)
Entity type:Individual
Prefix:
First Name:YASHEA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 E 143RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4804
Mailing Address - Country:US
Mailing Address - Phone:216-867-7930
Mailing Address - Fax:
Practice Address - Street 1:1300 E 9TH ST STE 1210
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1513
Practice Address - Country:US
Practice Address - Phone:216-867-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006446175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist