Healthcare Provider Details

I. General information

NPI: 1942874805
Provider Name (Legal Business Name): FAHIMA AKTAR BANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2273
  • Fax:
Mailing address:
  • Phone: 847-275-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.155937
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: