Provider Demographics
NPI:1356003297
Name:FAETANINI, SARAH MARIE
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIE
Last Name:FAETANINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6079 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2821
Mailing Address - Country:US
Mailing Address - Phone:440-306-0011
Mailing Address - Fax:440-306-0022
Practice Address - Street 1:6079 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-2821
Practice Address - Country:US
Practice Address - Phone:440-306-0011
Practice Address - Fax:440-306-0022
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist