Provider Demographics
NPI:1730900671
Name:SCOTT-ROSE, SHAUNA M
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:SCOTT-ROSE
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 1:6792 EMERSON LN
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3754
Mailing Address - Country:US
Mailing Address - Phone:216-406-9280
Mailing Address - Fax:
Practice Address - Street 1:6792 EMERSON LN
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3754
Practice Address - Country:US
Practice Address - Phone:216-406-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator