Healthcare Provider Details

I. General information

NPI: 1558354977
Provider Name (Legal Business Name): JEFFREY SANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 TALLMADGE RD STE. 120
CUYAHOGA FALLS OH
44221-3362
US

IV. Provider business mailing address

405 TALLMADGE RD STE. 120
CUYAHOGA FALLS OH
44221-3362
US

V. Phone/Fax

Practice location:
  • Phone: 330-784-9306
  • Fax: 330-475-7544
Mailing address:
  • Phone: 330-784-9306
  • Fax: 330-475-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35076954S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: