Healthcare Provider Details

I. General information

NPI: 1326576240
Provider Name (Legal Business Name): SHALONDA DERAY HARRIS PMHNP-BC, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 E 254TH ST
EUCLID OH
44132-2417
US

IV. Provider business mailing address

814 E 254TH ST 814 EAST 254TH STREET
EUCLID OH
44132-2417
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-4722
  • Fax:
Mailing address:
  • Phone: 216-798-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042150
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1400589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: