Healthcare Provider Details

I. General information

NPI: 1538434816
Provider Name (Legal Business Name): SHARELL J THAXTON DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 SNOW RD
PARMA OH
44130-1002
US

IV. Provider business mailing address

8584 WASHINGTON ST STE 2055
CHAGRIN FALLS OH
44023-5369
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-4428
  • Fax: 216-265-6801
Mailing address:
  • Phone: 216-404-6060
  • Fax: 440-708-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023369
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.023369
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.378816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: