Provider Demographics
NPI:1205398773
Name:STAYTON, ELIZA A (SLP)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:A
Last Name:STAYTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 RUMSEY DR
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:MD
Mailing Address - Zip Code:21673-1722
Mailing Address - Country:US
Mailing Address - Phone:443-504-9629
Mailing Address - Fax:
Practice Address - Street 1:224 PHILLIP MORRIS DR STE 202
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2000
Practice Address - Country:US
Practice Address - Phone:302-217-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist