Healthcare Provider Details

I. General information

NPI: 1407198914
Provider Name (Legal Business Name): YELENA BOGATELLO AGPCNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 MAYFIELD RD STE 409
MAYFIELD HTS OH
44124-2214
US

IV. Provider business mailing address

6803 MAYFIELD RD
MAYFIELD HTS OH
44124-2271
US

V. Phone/Fax

Practice location:
  • Phone: 440-946-4662
  • Fax: 440-683-1882
Mailing address:
  • Phone: 440-946-4662
  • Fax: 440-683-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG08200167
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number292338
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.292338
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: