Provider Demographics
NPI:1417400136
Name:SEDANO, NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SEDANO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MASEVICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3700 PARK EAST DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4305
Mailing Address - Country:US
Mailing Address - Phone:216-593-7700
Mailing Address - Fax:
Practice Address - Street 1:3700 PARK EAST DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4305
Practice Address - Country:US
Practice Address - Phone:216-593-7700
Practice Address - Fax:216-593-7190
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019558363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology