Provider Demographics
NPI:1316916521
Name:VACCARO, PATRICK SLOAN (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:SLOAN
Last Name:VACCARO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8132
Mailing Address - Country:US
Mailing Address - Phone:330-334-5988
Mailing Address - Fax:
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-723-7246
Practice Address - Fax:330-725-7855
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA05372367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134425Medicaid
OH2134425Medicaid