Healthcare Provider Details

I. General information

NPI: 1023062700
Provider Name (Legal Business Name): SANDRA MASSULLO-SCHUBERT M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA MASSULLO-SCHUBERT M.D.

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 CLARK ST STE A
CAMBRIDGE OH
43725-9611
US

IV. Provider business mailing address

1251 CLARK ST
CAMBRIDGE OH
43725-9612
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-7772
  • Fax:
Mailing address:
  • Phone: 740-439-0733
  • Fax: 740-439-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35067486
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35067486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: