Healthcare Provider Details

I. General information

NPI: 1114556743
Provider Name (Legal Business Name): YASAMEEN FARDI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7031
  • Fax:
Mailing address:
  • Phone: 440-214-8026
  • Fax: 216-201-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58.031361
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.015608
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34.015608
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: