Provider Demographics
NPI:1730522434
Name:SAYLES, STEPHANIE BLACKBURN (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BLACKBURN
Last Name:SAYLES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5298 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9302
Mailing Address - Country:US
Mailing Address - Phone:513-770-4212
Mailing Address - Fax:513-770-4213
Practice Address - Street 1:5298 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9302
Practice Address - Country:US
Practice Address - Phone:513-770-4212
Practice Address - Fax:513-770-4213
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04308207N00000X
OH34.013027207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100481780Medicaid
OH0242493Medicaid