Provider Demographics
NPI:1679139455
Name:FUSKO, TONYA LYNN
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:FUSKO
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 1:805 N MAIN ST REAR
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2010
Mailing Address - Country:US
Mailing Address - Phone:330-305-9500
Mailing Address - Fax:330-305-9502
Practice Address - Street 1:805 N MAIN ST REAR
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2010
Practice Address - Country:US
Practice Address - Phone:330-305-9500
Practice Address - Fax:330-305-9502
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health