Provider Demographics
NPI:1346070554
Name:SAMONS, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SAMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1302
Mailing Address - Country:US
Mailing Address - Phone:216-870-4809
Mailing Address - Fax:
Practice Address - Street 1:3639 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-1302
Practice Address - Country:US
Practice Address - Phone:216-870-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health