Provider Demographics
NPI:1811745938
Name:ROZZEL, SHAMETRA (LAC)
Entity type:Individual
Prefix:
First Name:SHAMETRA
Middle Name:
Last Name:ROZZEL
Suffix:
Gender:X
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MEADOWLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3137
Mailing Address - Country:US
Mailing Address - Phone:216-618-0767
Mailing Address - Fax:
Practice Address - Street 1:9945 VAIL DR STE 5
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2985
Practice Address - Country:US
Practice Address - Phone:216-307-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist