Provider Demographics
NPI:1053052738
Name:SIDOTI, STEPHEN JAMES
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:SIDOTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1512
Mailing Address - Country:US
Mailing Address - Phone:440-381-4726
Mailing Address - Fax:
Practice Address - Street 1:70 BAKER ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1512
Practice Address - Country:US
Practice Address - Phone:440-381-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist