Provider Demographics
NPI:1841047438
Name:SCHERBAKOV, PHILLIP (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:SCHERBAKOV
Suffix:
Gender:M
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BROOKRUN DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1374
Mailing Address - Country:US
Mailing Address - Phone:330-808-3383
Mailing Address - Fax:
Practice Address - Street 1:25700 SCIENCE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7328
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH274113163WP0808X
OH2024066721363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty