Provider Demographics
NPI:1114637196
Name:STAMP, MIA TASHE
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:TASHE
Last Name:STAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 UPLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-1423
Mailing Address - Country:US
Mailing Address - Phone:234-863-1569
Mailing Address - Fax:
Practice Address - Street 1:336 UPLAND AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1423
Practice Address - Country:US
Practice Address - Phone:234-863-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle