Provider Demographics
NPI:1225839590
Name:STONUM, ANDREW ELIJAH
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ELIJAH
Last Name:STONUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 HARBOR ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1980
Mailing Address - Country:US
Mailing Address - Phone:440-969-3420
Mailing Address - Fax:
Practice Address - Street 1:283 HARBOR ST APT 1
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1980
Practice Address - Country:US
Practice Address - Phone:440-969-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide