Provider Demographics
NPI:1225443146
Name:STANGO P.A.
Entity Type:Organization
Organization Name:STANGO P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING ASSOCIATE
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-378-4661
Mailing Address - Street 1:10740 N CENTRAL EXPY
Mailing Address - Street 2:STE.275
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2161
Mailing Address - Country:US
Mailing Address - Phone:214-378-4661
Mailing Address - Fax:888-624-8659
Practice Address - Street 1:595 N COURTENAY PKWY
Practice Address - Street 2:STE. 101
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4851
Practice Address - Country:US
Practice Address - Phone:214-378-4661
Practice Address - Fax:888-624-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48748208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty