Provider Demographics
NPI:1063521565
Name:MARKARIAN, SALLY M (CNS)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:M
Last Name:MARKARIAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 LAKE HARBOUR WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3248
Mailing Address - Country:US
Mailing Address - Phone:216-778-5480
Mailing Address - Fax:216-778-4025
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-5480
Practice Address - Fax:216-778-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 083431163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2673423Medicaid
OHQ70813Medicare UPIN
OHMANS75541Medicare ID - Type Unspecified