Provider Demographics
NPI:1093350373
Name:STANSEL, JAYDE AINSLEE
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:AINSLEE
Last Name:STANSEL
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 1:423 IRVING WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7612
Mailing Address - Country:US
Mailing Address - Phone:850-319-9082
Mailing Address - Fax:
Practice Address - Street 1:423 IRVING WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-7612
Practice Address - Country:US
Practice Address - Phone:850-319-9082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports