Healthcare Provider Details

I. General information

NPI: 1295728764
Provider Name (Legal Business Name): SANDY P NAPLES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 CLINGAN RD SUITE C
POLAND OH
44514-2159
US

IV. Provider business mailing address

6615 CLINGAN RD SUITE C
POLAND OH
44514-2159
US

V. Phone/Fax

Practice location:
  • Phone: 330-757-7888
  • Fax: 330-757-4912
Mailing address:
  • Phone: 330-757-7888
  • Fax: 330-757-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: