Healthcare Provider Details

I. General information

NPI: 1093016040
Provider Name (Legal Business Name): STEPHANIE YVONNE JANUSZKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 ALLIANCE RD STE 130
BLUE ASH OH
45242-4766
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 216-478-9208
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: