Healthcare Provider Details

I. General information

NPI: 1053206029
Provider Name (Legal Business Name): NISHANT MENON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 EUCLID AVE
CLEVELAND OH
44106-4711
US

IV. Provider business mailing address

9501 EUCLID AVE
CLEVELAND OH
44106-4711
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-0778
  • Fax:
Mailing address:
  • Phone: 216-368-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.010626RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: