Healthcare Provider Details

I. General information

NPI: 1205535606
Provider Name (Legal Business Name): MRS. MELISSA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA HAWKINS

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

14510 SUPERIOR RD
CLEVELAND HEIGHTS OH
44118-2126
US

V. Phone/Fax

Practice location:
  • Phone: 216-859-2727
  • Fax:
Mailing address:
  • Phone: 216-482-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: