Healthcare Provider Details

I. General information

NPI: 1659021095
Provider Name (Legal Business Name): SARA KENNEDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA HENRY

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 YANKEE RD STE 100
LIBERTY TOWNSHIP OH
45044-0007
US

IV. Provider business mailing address

7335 YANKEE RD STE 100
LIBERTY TOWNSHIP OH
45044-0007
US

V. Phone/Fax

Practice location:
  • Phone: 513-336-6700
  • Fax: 513-759-8201
Mailing address:
  • Phone: 513-336-6700
  • Fax: 513-759-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.252644
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.152683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: