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General NPI Number Information
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NPI Number | 1215211529
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Entity Type | Individual
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Provider Name | STACEY MARIE DIANTONIO PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 4124 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-2979
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Country | US
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Telephone | 234-410-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 29111 CEDAR RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-4005
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Country | US
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Telephone | 440-646-1600
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Fax | 440-646-1505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003342
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License Number State | OH
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