Provider Demographics
NPI:1477936656
Name:STANBACK, NIKEDA
Entity Type:Individual
Prefix:
First Name:NIKEDA
Middle Name:
Last Name:STANBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20283 STATE ROAD 7 STE 400
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6904
Mailing Address - Country:US
Mailing Address - Phone:954-866-1430
Mailing Address - Fax:
Practice Address - Street 1:20283 STATE ROAD 7 STE 400
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6904
Practice Address - Country:US
Practice Address - Phone:954-866-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst