Healthcare Provider Details

I. General information

NPI: 1639081268
Provider Name (Legal Business Name): MELISSA SHANTELL SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

5416 GARY AVE
BEDFORD HEIGHTS OH
44146-1751
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-2140
  • Fax:
Mailing address:
  • Phone: 216-990-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberCNP.0043405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: