Healthcare Provider Details

I. General information

NPI: 1922803923
Provider Name (Legal Business Name): LISA SHAHEEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6665 GROVE LN
CLEVELAND OH
44134-6962
US

IV. Provider business mailing address

6665 GROVE LN
CLEVELAND OH
44134-6962
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-9819
  • Fax:
Mailing address:
  • Phone: 216-444-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.004109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: