Healthcare Provider Details

I. General information

NPI: 1356796429
Provider Name (Legal Business Name): VASILIKI A VAMVAKIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 STUTZ DR STE 102
CANFIELD OH
44406-8149
US

IV. Provider business mailing address

542 NEOKA DR
CAMPBELL OH
44405-1261
US

V. Phone/Fax

Practice location:
  • Phone: 330-702-1585
  • Fax: 330-702-1383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.136119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: