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NPI Code Detail

MEDICARE: MRS. SHANNA F BOTOS CPNP

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
1363LP0200XPediatric Nurse PractitionerNP08422OH

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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