Provider Demographics
NPI:1790287845
Name:CALABRESE, STEPHANIE SELINA (BA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SELINA
Last Name:CALABRESE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11890 FAIRHILL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1053
Mailing Address - Country:US
Mailing Address - Phone:216-791-8000
Mailing Address - Fax:216-373-1820
Practice Address - Street 1:11890 FAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1053
Practice Address - Country:US
Practice Address - Phone:216-791-8000
Practice Address - Fax:216-373-1820
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty