Healthcare Provider Details

I. General information

NPI: 1720490519
Provider Name (Legal Business Name): MELISSA ERIN MCENERY-STONELAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVENUE A60 CLEVELAND CLINIC DERMATOLOGY & PLASTIC SURGERY INSTITUT
CLEVELAND OH
44195
US

IV. Provider business mailing address

CLEVELAND CLINIC DERMATOLOGY & PLASTIC SURG INSTITUTE 9500 EUCLID AVE A60
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5489
  • Fax:
Mailing address:
  • Phone: 216-444-5489
  • Fax: 216-636-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.133541
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03149
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: