Basic Information
| Provider Information | |||||||||
| NPI: | 1902824527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MODLIN | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | F | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441956805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164442200 | ||||||||
| FaxNumber: | 2166362043 | ||||||||
| Practice Location | |||||||||
| Address1: | 20000 HARVARD AVE | ||||||||
| Address2: | |||||||||
| City: | WARRENSVILLE HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441226805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164916000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35.064537 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35-064537 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0017013500001 | 05 | PA | MEDICAID | 1902824527 | 01 | MI | MICHIGAN MEDICAID | OTHER | 0926789 | 05 | OH | MEDICAID | 4337359 | 01 | OH | AETNA | OTHER | 000000221067 | 01 | OH | UNISON | OTHER | 0583328 | 01 | OH | BCMH | OTHER | 363852 | 01 | OH | WELLCARE MEDICAID | OTHER | 000000516049 | 01 | OH | ANTHEM | OTHER | 1902824527 | 01 | IN | INDIANA MEDICAID | OTHER | 727584 | 01 | OH | BUCKEYE MEDICAID | OTHER |