Healthcare Provider Details

I. General information

NPI: 1861077265
Provider Name (Legal Business Name): CENTER FOR BEHAVIORAL HEALTH AND SLEEP DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E WASHINGTON ST STE 200
MEDINA OH
44256-3331
US

IV. Provider business mailing address

3364 PRAIRIE VISTA CT
RICHFIELD OH
44286-9079
US

V. Phone/Fax

Practice location:
  • Phone: 234-564-6646
  • Fax: 234-517-6646
Mailing address:
  • Phone: 234-564-6646
  • Fax: 234-517-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMALA S ADURY
Title or Position: OWNER OF ENTITY
Credential: MD
Phone: 234-564-6646