Healthcare Provider Details

I. General information

NPI: 1275880080
Provider Name (Legal Business Name): BETH MELLORS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 CARNEGIE AVENUE # CA51
CLEVELAND OH
44195-3733
US

IV. Provider business mailing address

10201 CARNEGIE AVE
CLEVELAND OH
44106-2130
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-7269
  • Fax: 216-444-0924
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.18559
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337089-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberAPRN.CNP.18559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: