MEDICARE: DR. SANFORD WALDMAN MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	35020638W	OH

General Provider Information

NPI Number	:	1457474231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANFORD WALDMAN MD

Provider Business Mailing Address
First Line	:	30 DEEP CREEK LN
Second Line	:
City	:	MORELAND HILLS
State	:	OH
Zip	:	44022-1301
Country	:	US
Telephone Number	:	440-247-1423
Fax Number	:	440-247-8324

Provider Business Practice Location Address
First Line	:	30 DEEP CREEK LN
Second Line	:
City	:	MORELAND HILLS
State	:	OH
Zip	:	44022-1301
Country	:	US
Telephone Number	:	440-247-1423
Fax Number	:	440-247-8324

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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