MEDICARE: SALLY GHASSAN FARAH MSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1114881331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY GHASSAN FARAH MSC

Provider Business Mailing Address
First Line	:	3704 WYNDHAM RIDGE DR APT 207
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-6157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10524 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:	216-946-5882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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