Healthcare Provider Details

I. General information

NPI: 1588141261
Provider Name (Legal Business Name): OLESYA RABOSYUK CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

4665 DOUGLAS CIR NW # 100
CANTON OH
44718-3673
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-1000
  • Fax:
Mailing address:
  • Phone: 330-499-5700
  • Fax: 330-498-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67.000329
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: