Healthcare Provider Details

I. General information

NPI: 1528989613
Provider Name (Legal Business Name): SALLY P. GRABOVAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 PENNY LN
YOUNGSTOWN OH
44515-4923
US

IV. Provider business mailing address

1762 PENNY LN
YOUNGSTOWN OH
44515-4923
US

V. Phone/Fax

Practice location:
  • Phone: 330-503-5480
  • Fax:
Mailing address:
  • Phone: 330-503-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: