Healthcare Provider Details

I. General information

NPI: 1033474598
Provider Name (Legal Business Name): AZIZA A WAHBY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 CROCKER RD STE 300
WESTLAKE OH
44145
US

IV. Provider business mailing address

2971 PAXTON RD
SHAKER HTS OH
44120-1823
US

V. Phone/Fax

Practice location:
  • Phone: 440-646-1600
  • Fax: 440-646-1505
Mailing address:
  • Phone: 216-932-5200
  • Fax: 216-932-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34011998
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: