1407876816 NPI number — DEBORAH LOUISE SANO PH.D.

Table of content: DEBORAH LOUISE SANO PH.D. (NPI 1407876816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407876816 NPI number — DEBORAH LOUISE SANO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANO
Provider First Name:
DEBORAH
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407876816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406-0114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-506-9610
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7010 SOUTH AVE STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOARDMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-953-0373
Provider Business Practice Location Address Fax Number:
330-953-1373
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6301011855 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6627 . This is a "OHIO LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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