Provider Demographics
NPI:1801017082
Name:MASIELLA, CANDACE R
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:MASIELLA
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 1:1894 SPRINGFIELD LAKE BLVD
Mailing Address - Street 2:APT 204
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3083
Mailing Address - Country:US
Mailing Address - Phone:330-798-0486
Mailing Address - Fax:
Practice Address - Street 1:2795 SWEET FLAG WAY
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-753-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415256Medicaid