Provider Demographics
NPI:1023745916
Name:SHRODEK, ALISSA LOREN (RN, PMHNP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:LOREN
Last Name:SHRODEK
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:LOREN
Other - Last Name:RUSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PMHNP
Mailing Address - Street 1:527 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1227
Mailing Address - Country:US
Mailing Address - Phone:330-797-0070
Mailing Address - Fax:330-797-9146
Practice Address - Street 1:550 W CHALMERS AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1576
Practice Address - Country:US
Practice Address - Phone:330-797-0070
Practice Address - Fax:330-797-9146
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.416616163WA0400X, 163W00000X
OHAPRN.CNP.0032017363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
15688674OtherCAQH
OH0001368Medicaid