Healthcare Provider Details

I. General information

NPI: 1780731711
Provider Name (Legal Business Name): WOLODYMYR R. STASIUK ACA, BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 GLANCY ST
GOODLETTSVILLE TN
37072-2306
US

IV. Provider business mailing address

124 GLANCY ST
GOODLETTSVILLE TN
37072-2306
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-3901
  • Fax: 615-851-3903
Mailing address:
  • Phone: 615-851-3901
  • Fax: 615-851-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number410
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: