Healthcare Provider Details

I. General information

NPI: 1255723508
Provider Name (Legal Business Name): STEPHANIE FOSTER PA-C, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

2768 STUBBINS RD
BRECKSVILLE OH
44141-4020
US

V. Phone/Fax

Practice location:
  • Phone: 330-289-4619
  • Fax:
Mailing address:
  • Phone: 330-289-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007114RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: