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General NPI Number Information
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NPI Number | 1144888165
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Entity Type | Individual
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Provider Name | JESSICA SUBA DO
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Gender | Female
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 328 E HINES HILL RD
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City | HUDSON
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State | OH
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Zip | 44236-1118
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Country | US
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Telephone | 330-543-8260
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Fax | 330-543-2155
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Provider Business Mailing Address
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Address Line | 328 E HINES HILL RD
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City | HUDSON
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State | OH
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Zip | 44236-1118
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Country | US
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Telephone | 330-543-8260
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Fax | 330-543-2155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | 34.015824
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License Number State | OH
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