Healthcare Provider Details

I. General information

NPI: 1518879485
Provider Name (Legal Business Name): SAMANTHA ZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5219
US

IV. Provider business mailing address

4946 AUTUMNWOOD LN
BRUNSWICK OH
44212-4722
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: