Healthcare Provider Details

I. General information

NPI: 1154719243
Provider Name (Legal Business Name): SABRINA L KIRKSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7414 PARK AVENUE
CLEVELAND OH
44105
US

IV. Provider business mailing address

7414 PARK AVE
CLEVELAND OH
44105-5062
US

V. Phone/Fax

Practice location:
  • Phone: 216-288-2421
  • Fax:
Mailing address:
  • Phone: 216-288-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRM780983
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: