Provider Demographics
NPI:1851735310
Name:MASON, SHELLEY DIANE
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DIANE
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MAYFIELD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2208
Mailing Address - Country:US
Mailing Address - Phone:440-312-4659
Mailing Address - Fax:440-312-4597
Practice Address - Street 1:6801 MAYFIELD RD STE 250
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2208
Practice Address - Country:US
Practice Address - Phone:440-312-4659
Practice Address - Fax:440-312-4597
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 203662 COA1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health