Healthcare Provider Details

I. General information

NPI: 1689694952
Provider Name (Legal Business Name): JOHN JOSEPH SANITATO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 PEARL RD STE 100
CLEVELAND OH
44130-3640
US

IV. Provider business mailing address

6900 PEARL RD STE 100
CLEVELAND OH
44130-3640
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-2400
  • Fax: 216-292-1001
Mailing address:
  • Phone: 216-844-2400
  • Fax: 216-292-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35-075148
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-075148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: