Provider Demographics
NPI:1619289519
Name:STASIO, GUINEVERE A (CCC-A)
Entity Type:Individual
Prefix:DR
First Name:GUINEVERE
Middle Name:A
Last Name:STASIO
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 MAIN ST.
Mailing Address - Street 2:ATLANTIC AUDIOLOGY
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3990
Mailing Address - Country:US
Mailing Address - Phone:781-246-0305
Mailing Address - Fax:781-246-7576
Practice Address - Street 1:979 MAIN ST
Practice Address - Street 2:ATLANTIC AUDIOLOGY
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3990
Practice Address - Country:US
Practice Address - Phone:781-246-0305
Practice Address - Fax:781-246-7576
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA934231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist