Provider Demographics
NPI:1518937713
Name:STANESCU, STEFAN L (MD)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:L
Last Name:STANESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE C300
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5191
Mailing Address - Country:US
Mailing Address - Phone:904-797-2663
Mailing Address - Fax:904-819-0997
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C300
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5191
Practice Address - Country:US
Practice Address - Phone:904-797-2663
Practice Address - Fax:904-819-0997
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076144207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254950601Medicaid
FL5929627OtherAETNA
FL43694OtherBLUE CROSS BLUE SHIELD FL
FLG74685Medicare UPIN
FL43694Medicare ID - Type Unspecified