Individual
ANGELIQUE SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7337
Mailing address
3605 WARRENSVILLE CENTER RD, 1ST FLOOR, SHAKER HTS, OH 44122-5203
(216) 286-6260
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1410
GA
367H00000X
Anesthesiologist Assistant
Primary
67.000125
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000232325
UNISON
OH
01
—
000000515975
ANTHEM
OH
01
—
0583328
BCMH
OH
01
—
1978
BIRTH YEAR
OH
05
—
2777651
—
OH
01
—
417995
WELLCARE MEDICAID
OH
01
—
7890925
AETNA
OH
Enumeration date
10/17/2006
Last updated
05/19/2008
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