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General NPI Number Information
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NPI Number | 1538343231
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Entity Type | Organization
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Legal Business Name | SANDY VALLEY PROF INC
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 10025 CLEVELAND AVE SE
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City | MAGNOLIA
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State | OH
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Zip | 44643-9781
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Country | US
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Telephone | 330-866-3309
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Fax | 330-866-3077
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | EAST SPARTA
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State | OH
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Zip | 44626-0419
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Country | US
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Telephone | 330-866-3309
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Fax | 330-866-3077
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | FRANCESCA P NICOLETTI
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Credential |
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Telephone | 330-866-3309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 75313
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License Number State | OH
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