MEDICARE: SHANTA COLEMAN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1457200123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTA COLEMAN

Provider Business Mailing Address
First Line	:	12901 ABELL AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-3820
Country	:	US
Telephone Number	:	440-255-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	9220 MENTOR AVE
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6412
Country	:	US
Telephone Number	:	440-255-1700
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ SHANTA COLEMAN ” Practice Location

Language	Start Address	Practice Location

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