MEDICARE: BETH MELLORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	APRN.CNP.18559	OH
2	363LF0000X	Family Nurse Practitioner	F337089-1	NY
3	363L00000X	Nurse Practitioner	APRN.CNP.18559	OH

General Provider Information

NPI Number	:	1275880080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH MELLORS

Provider Business Mailing Address
First Line	:	10201 CARNEGIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10201 CARNEGIE AVENUE # CA51
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3733
Country	:	US
Telephone Number	:	216-445-7269
Fax Number	:	216-444-0924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	11/17/2022

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Directions to “ BETH MELLORS ” Practice Location

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