Provider Demographics
NPI:1548499833
Name:JAY, SANDRA L
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:JAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:STRAFFEN JAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 AKRON GENERAL AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2432
Mailing Address - Country:US
Mailing Address - Phone:330-344-6525
Mailing Address - Fax:330-996-2943
Practice Address - Street 1:4125 MEDINA RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-344-6525
Practice Address - Fax:330-996-2943
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003036101YP2500X
OHRN 225855163WP0809X
OHCOA 15232 NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0095290Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OHH235300Medicare PIN