Provider Demographics
NPI:1205352424
Name:GOLDSTEIN-PTAHIA, SHANA RUTH (CNM)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RUTH
Last Name:GOLDSTEIN-PTAHIA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:RUTH
Other - Last Name:PTAHIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:51 PARK WEST BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 PARK WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4215
Practice Address - Country:US
Practice Address - Phone:234-312-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019341367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife