Healthcare Provider Details

I. General information

NPI: 1235184706
Provider Name (Legal Business Name): SAMEEP DILIP MANIAR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

660 ACKERMAN RD 3RD FLOOR PO BOX 183103
COLUMBUS OH
43218-3103
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number6034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: