MEDICARE: MELISSA AMIT SHUCK LMT

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	225700000X	Massage Therapist	33.026026	OH

General Provider Information

NPI Number	:	1912627035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA AMIT SHUCK LMT

Provider Business Mailing Address
First Line	:	3545 GROSVENOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2628
Country	:	US
Telephone Number	:	818-324-5632
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 GROSVENOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2628
Country	:	US
Telephone Number	:	818-324-5632
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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