Provider Demographics
NPI:1982927760
Name:SADID, SANDRA (PAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SADID
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 ALLEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1070
Mailing Address - Country:US
Mailing Address - Phone:330-945-7246
Mailing Address - Fax:330-945-9920
Practice Address - Street 1:4302 ALLEN RD STE 300
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1070
Practice Address - Country:US
Practice Address - Phone:330-945-7246
Practice Address - Fax:330-945-9920
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000488363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22592OtherPTAN