Healthcare Provider Details

I. General information

NPI: 1497073514
Provider Name (Legal Business Name): SOWMYA RAO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

230 EATON RIDGE DR APT 104
SAGAMORE HILLS OH
44067-4511
US

V. Phone/Fax

Practice location:
  • Phone: 469-450-0079
  • Fax:
Mailing address:
  • Phone: 469-450-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06752
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5047
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: