Healthcare Provider Details

I. General information

NPI: 1225920820
Provider Name (Legal Business Name): NIKKI FAGHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.004980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: