MEDICARE: MELISSA D BRECKENRIDGE

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	251J00000X	Nursing Care Agency	400508160605	OH

General Provider Information

NPI Number	:	1851033831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA D BRECKENRIDGE

Provider Business Mailing Address
First Line	:	3573 PENNINGTON RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-5013
Country	:	US
Telephone Number	:	216-983-9433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3573 PENNINGTON RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-5013
Country	:	US
Telephone Number	:	216-983-9433
Fax Number	:

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

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	04/11/2022

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Directions to “ MELISSA D BRECKENRIDGE ” Practice Location

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