MEDICARE: MRS. HATINA SHONTI DANIEL RN

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	163W00000X	Registered Nurse	RN380302	OH

General Provider Information

NPI Number	:	1790047405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HATINA SHONTI DANIEL RN

Provider Business Mailing Address
First Line	:	14317 WESTROPP AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1828
Country	:	US
Telephone Number	:	216-849-8567
Fax Number	:	216-486-6870

Provider Business Practice Location Address
First Line	:	14317 WESTROPP AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1828
Country	:	US
Telephone Number	:	216-849-8567
Fax Number	:	216-486-6870

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

Provider Enumeration Date	:	06/10/2012
Last Update Date	:	06/25/2012

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