Provider Demographics
NPI:1003563511
Name:STANNEY, OSHETISI JAMILLAH (CNP, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:OSHETISI
Middle Name:JAMILLAH
Last Name:STANNEY
Suffix:
Gender:F
Credentials:CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 STEEPLE ST STE 202-37
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3287
Mailing Address - Country:US
Mailing Address - Phone:508-375-7936
Mailing Address - Fax:
Practice Address - Street 1:13 STEEPLE ST STE 202-37
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3287
Practice Address - Country:US
Practice Address - Phone:508-375-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN71708163WP0808X
MARN2326428363LP0808X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health