MEDICARE: SHELLEY DIANE MASON

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	363LA2200X	Adult Health Nurse Practitioner	RN 203662 COA1	OH

General Provider Information

NPI Number	:	1851735310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY DIANE MASON

Provider Business Mailing Address
First Line	:	6801 MAYFIELD RD STE 250
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2208
Country	:	US
Telephone Number	:	440-312-4659
Fax Number	:	440-312-4597

Provider Business Practice Location Address
First Line	:	6801 MAYFIELD RD STE 250
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2208
Country	:	US
Telephone Number	:	440-312-4659
Fax Number	:	440-312-4597

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

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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Directions to “ SHELLEY DIANE MASON ” Practice Location

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