Healthcare Provider Details

I. General information

NPI: 1215130786
Provider Name (Legal Business Name): SALLY IBRAHIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE # RBC3001
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE # RBC3001
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3267
  • Fax:
Mailing address:
  • Phone: 216-844-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number35.090334
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35.090334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: