Provider Demographics
NPI:1235132606
Name:SADY, STANLEY P (MD , PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:P
Last Name:SADY
Suffix:
Gender:M
Credentials:MD , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E BOULDER ST
Mailing Address - Street 2:PSSB SUITE 1200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:719-365-6999
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB SUITE 1200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-7985
Practice Address - Fax:916-734-2975
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0057730207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ9598Medicaid
MO209441005Medicaid
CO50150537Medicaid
NM52628Medicaid
NMNM009C89OtherBLUE CROSS BLUE SHEILD
NC7613812Medicaid
AZ474776Medicaid
NM961251OtherPRONET / AETNA
NM050070099Medicare ID - Type UnspecifiedRIAL ROAD MEDICARE
NM52628Medicaid