Healthcare Provider Details

I. General information

NPI: 1871013656
Provider Name (Legal Business Name): SEYED SAHAND BANISADR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SEYED SAHAND BANISADR MD

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR FL E
TOLEDO OH
43606-3856
US

IV. Provider business mailing address

213 CARNEGIE PL
PITTSBURGH PA
15208-2705
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-7322
  • Fax: 419-479-2617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0027797
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.030449
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR0069674
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: