Provider Demographics
NPI:1306400098
Name:STAHL, OLIVIA J (PA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:J
Last Name:STAHL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1059
Mailing Address - Country:US
Mailing Address - Phone:716-598-2035
Mailing Address - Fax:
Practice Address - Street 1:133 BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1059
Practice Address - Country:US
Practice Address - Phone:716-598-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program