Provider Demographics
NPI:1578336905
Name:MANTON, STEPHEN SAMUEL
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SAMUEL
Last Name:MANTON
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 1:840 GINO LN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3788
Mailing Address - Country:US
Mailing Address - Phone:440-521-3688
Mailing Address - Fax:
Practice Address - Street 1:840 GINO LN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3788
Practice Address - Country:US
Practice Address - Phone:440-521-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker