Healthcare Provider Details

I. General information

NPI: 1801538962
Provider Name (Legal Business Name): MELISSA MALLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3170
US

IV. Provider business mailing address

31268 BISHOPS GATE CIR
WESTLAKE OH
44145-3762
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2122
  • Fax: 440-312-9251
Mailing address:
  • Phone: 216-870-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN307980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: