Provider Demographics
NPI:1447846191
Name:SWEENEY, TRACEY L
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:SWEENEY
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 1:5676 BROADVIEW RD APT 320
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1674
Mailing Address - Country:US
Mailing Address - Phone:216-789-3744
Mailing Address - Fax:
Practice Address - Street 1:5676 BROADVIEW RD APT 320
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44134-1674
Practice Address - Country:US
Practice Address - Phone:216-789-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker