Healthcare Provider Details

I. General information

NPI: 1841047438
Provider Name (Legal Business Name): PHILLIP SCHERBAKOV RN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

IV. Provider business mailing address

135 BROOKRUN DR
COPLEY OH
44321-1374
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax:
Mailing address:
  • Phone: 330-808-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number274113
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024066721
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: