Provider Demographics
NPI:1144888165
Name:SUBA, JESSICA (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SUBA
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 1:328 E HINES HILL RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1118
Mailing Address - Country:US
Mailing Address - Phone:330-543-8260
Mailing Address - Fax:330-543-2155
Practice Address - Street 1:328 E HINES HILL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1118
Practice Address - Country:US
Practice Address - Phone:330-543-8260
Practice Address - Fax:330-543-2155
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0158242080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine