Healthcare Provider Details

I. General information

NPI: 1336757350
Provider Name (Legal Business Name): SABEEHA NAAZNEEN SHAIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE
FREMONT OH
43420-3237
US

IV. Provider business mailing address

2575 HAYES AVE STE 1
FREMONT OH
43420-5201
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-6679
  • Fax: 419-334-6690
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.147875
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: