Provider Demographics
NPI:1306818133
Name:STANLEY-CHRISTIAN, HEATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:STANLEY-CHRISTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17323 PAGONIA DR STE 227
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5997
Mailing Address - Country:US
Mailing Address - Phone:352-404-5544
Mailing Address - Fax:352-404-5912
Practice Address - Street 1:17323 PAGONIA DR STE 227
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5997
Practice Address - Country:US
Practice Address - Phone:352-404-5544
Practice Address - Fax:352-404-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104036207SG0201X, 207VM0101X
ARE-15933207VM0101X
WI52030207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100427600Medicaid
MDG95931Medicare UPIN