Provider Demographics
NPI:1043495542
Name:MAYO, STEPHANIE M (APRN,BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MAYO
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:MAROK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,BC
Mailing Address - Street 1:7959 LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254
Mailing Address - Country:US
Mailing Address - Phone:216-832-5863
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-832-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09516363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health