Provider Demographics
NPI:1508421660
Name:HEATHER STANLEY-CHRISTIAN, MD PA
Entity Type:Organization
Organization Name:HEATHER STANLEY-CHRISTIAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY-CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-404-5544
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-04
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100427600Medicaid