Healthcare Provider Details

I. General information

NPI: 1558289983
Provider Name (Legal Business Name): AMANDA FAKIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24865 DETROIT RD
WESTLAKE OH
44145-2512
US

IV. Provider business mailing address

27243 WESTOWN BLVD APT 306
WESTLAKE OH
44145-4520
US

V. Phone/Fax

Practice location:
  • Phone: 440-250-8800
  • Fax:
Mailing address:
  • Phone: 216-312-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberUS016014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: