Healthcare Provider Details

I. General information

NPI: 1548499833
Provider Name (Legal Business Name): SANDRA L JAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA L STRAFFEN JAY

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEDINA RD
AKRON OH
44333-2483
US

IV. Provider business mailing address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6525
  • Fax: 330-996-2943
Mailing address:
  • Phone: 330-344-6525
  • Fax: 330-996-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA 15232 NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0003036
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 225855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: