Healthcare Provider Details

I. General information

NPI: 1114724564
Provider Name (Legal Business Name): MELINDA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15925 VAN AKEN BLVD APT 305E
SHAKER HEIGHTS OH
44120-5383
US

IV. Provider business mailing address

15925 VAN AKEN BLVD APT 305E
SHAKER HEIGHTS OH
44120-5383
US

V. Phone/Fax

Practice location:
  • Phone: 757-383-3148
  • Fax:
Mailing address:
  • Phone: 757-383-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number603023310425
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: