Healthcare Provider Details

I. General information

NPI: 1083947865
Provider Name (Legal Business Name): TIFFANY DION CUNDIFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 THORNTON ST NW
CANTON OH
44720-4893
US

IV. Provider business mailing address

3003 THORNTON ST NW
CANTON OH
44720-4893
US

V. Phone/Fax

Practice location:
  • Phone: 330-617-9710
  • Fax: 234-347-0009
Mailing address:
  • Phone: 330-617-9710
  • Fax: 234-347-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN543939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: