Provider Demographics
NPI:1801358700
Name:SARIDAKIS, STEPHANIE NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:SARIDAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 BRECKSVILLE RD STE 50
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1950
Mailing Address - Country:US
Mailing Address - Phone:440-792-4802
Mailing Address - Fax:440-792-4768
Practice Address - Street 1:8751 BRECKSVILLE RD STE 50
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1950
Practice Address - Country:US
Practice Address - Phone:440-792-4802
Practice Address - Fax:440-792-4768
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016592207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34.016592OtherELICENSURE