Healthcare Provider Details

I. General information

NPI: 1689036535
Provider Name (Legal Business Name): PAUL SABO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FRANKLIN ST
NORTH ADAMS MA
01247-2712
US

IV. Provider business mailing address

11800 ALPHA RD
HIRAM OH
44234-9773
US

V. Phone/Fax

Practice location:
  • Phone: 413-664-4041
  • Fax:
Mailing address:
  • Phone: 330-388-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2015265
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101698
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: