Healthcare Provider Details

I. General information

NPI: 1275722894
Provider Name (Legal Business Name): NESDININC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 MEADOW LANE CT STE 3
ELYRIA OH
44035-1485
US

IV. Provider business mailing address

PO BOX 296
AVON LAKE OH
44012-0296
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-5443
  • Fax: 440-934-1077
Mailing address:
  • Phone: 440-934-5443
  • Fax: 440-934-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35074130
License Number StateOH

VIII. Authorized Official

Name: DR. NESTOR G GAYOMALI
Title or Position: OWNER
Credential: MD
Phone: 440-934-5443