Healthcare Provider Details

I. General information

NPI: 1316916521
Provider Name (Legal Business Name): PATRICK SLOAN VACCARO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 E WASHINGTON ST SUITE 203
MEDINA OH
44256-3332
US

IV. Provider business mailing address

988 HIDDEN VALLEY DR
WADSWORTH OH
44281-8132
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7246
  • Fax: 330-725-7855
Mailing address:
  • Phone: 330-334-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA05372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: