Basic Information
Provider Information
NPI: 1891440715
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAJI
FirstName: HEPHZIBA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 N SUMMIT ST FL 15
Address2:  
City: TOLEDO
State: OH
PostalCode: 436041531
CountryCode: US
TelephoneNumber:  
FaxNumber: 8005645952
Practice Location
Address1: 3485 DAVISVILLE RD
Address2:  
City: HATBORO
State: PA
PostalCode: 190404220
CountryCode: US
TelephoneNumber: 8004271902
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/18/2022
LastUpdateDate: 02/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LG0600XAG12210104PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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