Provider Demographics
NPI:1275544744
Name:STANEK, VERONICA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:STANEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:211 NEW BRITAIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1360
Practice Address - Country:US
Practice Address - Phone:860-224-9879
Practice Address - Fax:860-224-0565
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000224363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS48053Medicare UPIN