Provider Demographics
NPI:1720490519
Name:MCENERY-STONELAKE, MELISSA ERIN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ERIN
Last Name:MCENERY-STONELAKE
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:CLEVELAND CLINIC DERMATOLOGY & PLASTIC SURG INSTITUTE
Mailing Address - Street 2:9500 EUCLID AVE A60
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-444-5489
Mailing Address - Fax:216-636-0863
Practice Address - Street 1:9500 EUCLID AVENUE A60
Practice Address - Street 2:CLEVELAND CLINIC DERMATOLOGY & PLASTIC SURGERY INSTITUT
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP03149207R00000X
390200000X
OH35.133541207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty