Healthcare Provider Details

I. General information

NPI: 1457474231
Provider Name (Legal Business Name): SANFORD WALDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 DEEP CREEK LN
MORELAND HILLS OH
44022-1301
US

IV. Provider business mailing address

30 DEEP CREEK LN
MORELAND HILLS OH
44022-1301
US

V. Phone/Fax

Practice location:
  • Phone: 440-247-1423
  • Fax: 440-247-8324
Mailing address:
  • Phone: 440-247-1423
  • Fax: 440-247-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35020638W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: