Healthcare Provider Details

I. General information

NPI: 1801998547
Provider Name (Legal Business Name): ROSELINE E OKON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35900 EUCLID AVE
WILLOUGHBY OH
44094-4623
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-3000
  • Fax:
Mailing address:
  • Phone: 440-684-5979
  • Fax: 440-684-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-087776
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35-087776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: