Provider Demographics
NPI:1699593137
Name:STANFIELD, JEREMY L
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:L
Last Name:STANFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6346
Mailing Address - Country:US
Mailing Address - Phone:330-631-5457
Mailing Address - Fax:
Practice Address - Street 1:1756 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6346
Practice Address - Country:US
Practice Address - Phone:330-631-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSV647229374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide