MEDICARE: DR. ELYSSA MOURANY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	RES.004452	OH

General Provider Information

NPI Number	:	1053040873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELYSSA MOURANY DDS

Provider Business Mailing Address
First Line	:	1633 AUBURN AVE APT 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5131
Country	:	US
Telephone Number	:	440-522-7544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 AUBURN AVE APT 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5131
Country	:	US
Telephone Number	:	440-522-7544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/07/2022

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