Provider Demographics
NPI:1174218200
Name:KENNEDY, ANTHONY TYRELL
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TYRELL
Last Name:KENNEDY
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 1:4053 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2610
Mailing Address - Country:US
Mailing Address - Phone:216-318-2043
Mailing Address - Fax:
Practice Address - Street 1:4053 BAYARD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2610
Practice Address - Country:US
Practice Address - Phone:216-318-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health