Provider Demographics
NPI:1003871849
Name:STANIEC, CHRISTIAN ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:STANIEC
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 W NASA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2605
Mailing Address - Country:US
Mailing Address - Phone:321-308-0659
Mailing Address - Fax:321-309-2881
Practice Address - Street 1:6032 FARCENDA PL
Practice Address - Street 2:#102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7341
Practice Address - Country:US
Practice Address - Phone:321-608-8160
Practice Address - Fax:321-622-6818
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
U6107AMedicare ID - Type Unspecified