MEDICARE: TRANSCENDENT TELEMEDICINE PRACTICE LLC

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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1720690050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSCENDENT TELEMEDICINE PRACTICE LLC

Provider Business Mailing Address
First Line	:	5241 WILSON MILLS RD STE 35C
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2150
Country	:	US
Telephone Number	:	440-221-2449
Fax Number	:	440-448-4912

Provider Business Practice Location Address
First Line	:	5241 WILSON MILLS RD STE 35C
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2150
Country	:	US
Telephone Number	:	440-221-2449
Fax Number	:	440-448-4912

Authorized Official
Title or Position	:	CEO
Name	:	MS. LASHELLE HENDERSON
Credential	:	MSN,FNP-BC, PMHNP-BC
Telephone Number	:	216-233-1983

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	04/13/2023

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