Provider Demographics
NPI:1669342101
Name:COFFEY, STEPHANIE SAMANTHA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SAMANTHA
Last Name:COFFEY
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 1:67 N MEDINA LINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9501
Mailing Address - Country:US
Mailing Address - Phone:216-253-4297
Mailing Address - Fax:216-253-4297
Practice Address - Street 1:67 N MEDINA LINE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9501
Practice Address - Country:US
Practice Address - Phone:216-253-4297
Practice Address - Fax:216-253-4297
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator