Provider Demographics
NPI:1609331388
Name:DADDARIO, SPENCER ALEXANDER
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:ALEXANDER
Last Name:DADDARIO
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:SERRA VISTA DR.
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:330-858-7473
Mailing Address - Fax:
Practice Address - Street 1:2723 SERRA VISTA DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1615
Practice Address - Country:US
Practice Address - Phone:330-858-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program