MEDICARE: MRS. SHANNA F BOTOS CPNP

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	363LP0200X	Pediatric Nurse Practitioner	NP08422	OH

General Provider Information

NPI Number	:	1629031281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNA F BOTOS CPNP

Provider Business Mailing Address
First Line	:	21211 S WOODLAND RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:	MAILSTOP S1-20
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-444-0537
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/19/2016

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