Provider Demographics
NPI:1578452488
Name:HUDSON, STACEY SALIHAH (CERTIFIED)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:SALIHAH
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 MAYFIELD RD
Mailing Address - Street 2:#1007
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3030
Mailing Address - Country:US
Mailing Address - Phone:216-802-8249
Mailing Address - Fax:
Practice Address - Street 1:5950 MAYFIELD RD
Practice Address - Street 2:#1007
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3030
Practice Address - Country:US
Practice Address - Phone:216-802-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist