Healthcare Provider Details

I. General information

NPI: 1821053729
Provider Name (Legal Business Name): DANIEL W SANDERS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/13/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 WEST MARKET STREET
FAIRLAWN OH
44333-4215
US

IV. Provider business mailing address

2680 WEST MARKET STREET
FAIRLAWN OH
44333-4215
US

V. Phone/Fax

Practice location:
  • Phone: 234-867-5001
  • Fax:
Mailing address:
  • Phone: 234-867-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3830
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: