Provider Demographics
NPI:1659315497
Name:SORIN, WENDY A (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:SORIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4941
Mailing Address - Country:US
Mailing Address - Phone:440-888-2333
Mailing Address - Fax:440-888-2335
Practice Address - Street 1:7575 NORTHCLIFF
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3267
Practice Address - Country:US
Practice Address - Phone:440-888-2333
Practice Address - Fax:440-888-2335
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0965684Medicaid
OHSO0756454Medicare ID - Type Unspecified
OHF75067Medicare UPIN