Provider Demographics
NPI:1760228076
Name:TUCKER-FASON, ALESIA YVETT (STNA, MA,)
Entity type:Individual
Prefix:
First Name:ALESIA
Middle Name:YVETT
Last Name:TUCKER-FASON
Suffix:
Gender:F
Credentials:STNA, MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 CARNEGIE AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2934
Mailing Address - Country:US
Mailing Address - Phone:440-841-0061
Mailing Address - Fax:
Practice Address - Street 1:8920 CARNEGIE AVE APT 208
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2934
Practice Address - Country:US
Practice Address - Phone:440-841-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist