Healthcare Provider Details

I. General information

NPI: 1417898024
Provider Name (Legal Business Name): STACEY KARSHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 W HARBOR RD
PORT CLINTON OH
43452-9035
US

IV. Provider business mailing address

3572 W HARBOR RD
PORT CLINTON OH
43452-9035
US

V. Phone/Fax

Practice location:
  • Phone: 419-707-1005
  • Fax:
Mailing address:
  • Phone: 419-707-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: