Provider Demographics
NPI:1588199665
Name:MERANDES, ANTOINETTE
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:MERANDES
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 1:1930 FULTON RD NW # 103
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3526
Mailing Address - Country:US
Mailing Address - Phone:330-956-5936
Mailing Address - Fax:330-956-5623
Practice Address - Street 1:1930 FULTON RD NW # 103
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3526
Practice Address - Country:US
Practice Address - Phone:330-956-5936
Practice Address - Fax:330-956-5623
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
OHLPN.034999.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)