Provider Demographics
NPI:1730850397
Name:AL YASSARY, SAFWAN
Entity type:Individual
Prefix:
First Name:SAFWAN
Middle Name:
Last Name:AL YASSARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8548 PAYSON DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7920
Mailing Address - Country:US
Mailing Address - Phone:614-822-5705
Mailing Address - Fax:
Practice Address - Street 1:8548 PAYSON DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7920
Practice Address - Country:US
Practice Address - Phone:614-822-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications