Healthcare Provider Details

I. General information

NPI: 1962313619
Provider Name (Legal Business Name): SHANTAE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD
GARFIELD HTS OH
44125-2967
US

IV. Provider business mailing address

9500 WADE PARK AVE APT 411
CLEVELAND OH
44106-4041
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone: 216-303-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: