MEDICARE: MRS. SHALONDA DERAY HARRIS PMHNP-BC, LPCC-S

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0042150	OH
2	101YP2500X	Professional Counselor	1400589	OH

General Provider Information

NPI Number	:	1326576240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHALONDA DERAY HARRIS PMHNP-BC, LPCC-S

Provider Business Mailing Address
First Line	:	814 E 254TH ST
Second Line	:	814 EAST 254TH STREET
City	:	EUCLID
State	:	OH
Zip	:	44132-2417
Country	:	US
Telephone Number	:	216-798-4722
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 E 254TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-2417
Country	:	US
Telephone Number	:	216-798-4722
Fax Number	:

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

Provider Enumeration Date	:	05/24/2017
Last Update Date	:	05/11/2026

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