Provider Demographics
NPI:1407963598
Name:STANDA, S SCOTT
Entity Type:Individual
Prefix:
First Name:S
Middle Name:SCOTT
Last Name:STANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 MARSCHALL RD
Mailing Address - Street 2:STE 106
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1678
Mailing Address - Country:US
Mailing Address - Phone:952-445-5390
Mailing Address - Fax:952-445-5394
Practice Address - Street 1:287 MARSCHALL RD
Practice Address - Street 2:STE 106
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1686
Practice Address - Country:US
Practice Address - Phone:952-445-5390
Practice Address - Fax:952-445-5394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN892825800Medicaid
MN791480266Medicare PIN
MN892825800Medicaid
T39672Medicare UPIN
MN0365880001Medicare NSC
MN480011304Medicare PIN