Healthcare Provider Details

I. General information

NPI: 1144888165
Provider Name (Legal Business Name): JESSICA SUBA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E HINES HILL RD
HUDSON OH
44236-1118
US

IV. Provider business mailing address

328 E HINES HILL RD
HUDSON OH
44236-1118
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8260
  • Fax: 330-543-2155
Mailing address:
  • Phone: 330-543-8260
  • Fax: 330-543-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number34.015824
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: