Healthcare Provider Details

I. General information

NPI: 1114223344
Provider Name (Legal Business Name): SAHERA DIRAJLAL-FARGO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAHERA DIRAJLAL DO

II. Dates (important events)

Enumeration Date: 02/05/2011
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

24701 EUCLID AVE 3RD FLOOR
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberDO034306
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number34-011092
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: