Healthcare Provider Details

I. General information

NPI: 1831527548
Provider Name (Legal Business Name): SHONTE MARIE HENDERSON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 MT HERMON AVE
CLEVELAND OH
44115-3377
US

IV. Provider business mailing address

27440 PINEVIEW DR
WESTLAKE OH
44145-4421
US

V. Phone/Fax

Practice location:
  • Phone: 216-526-9377
  • Fax:
Mailing address:
  • Phone: 216-219-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number499860
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number499860
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number499860
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number499860
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number499860
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number499860
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRW144016
License Number StateOH
# 9
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number499860
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: