Provider Demographics
NPI:1821053729
Name:SANDERS, DANIEL W (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 COMMUNITY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2356
Mailing Address - Country:US
Mailing Address - Phone:330-633-1206
Mailing Address - Fax:330-633-1364
Practice Address - Street 1:85 COMMUNITY RD
Practice Address - Street 2:SUITE F
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2356
Practice Address - Country:US
Practice Address - Phone:330-633-1206
Practice Address - Fax:330-633-1364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3830103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716532Medicaid
OH34183030600OtherWORKERS COMP
OHSACP29511Medicare ID - Type UnspecifiedPROVIDER #