Healthcare Provider Details

I. General information

NPI: 1528984317
Provider Name (Legal Business Name): VICTORIA JOSEPHINE SHEA MARTENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 PROSPECT AVE E
CLEVELAND OH
44115-2704
US

IV. Provider business mailing address

3622 PROSPECT AVE E
CLEVELAND OH
44115-2704
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-4600
  • Fax:
Mailing address:
  • Phone: 216-431-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: