Provider Demographics
NPI:1154938710
Name:STEFANSKI, EASHAN
Entity type:Individual
Prefix:
First Name:EASHAN
Middle Name:
Last Name:STEFANSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EASHAN
Other - Middle Name:
Other - Last Name:STEFANSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:459 CHARTER OAK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3059
Mailing Address - Country:US
Mailing Address - Phone:757-238-0635
Mailing Address - Fax:
Practice Address - Street 1:459 CHARTER OAK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3059
Practice Address - Country:US
Practice Address - Phone:757-238-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)