Provider Demographics
NPI:1538677141
Name:STANLEY, ANTTROY ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTTROY
Middle Name:ANTHONY
Last Name:STANLEY
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 1:1491 NE 151ST TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5963
Mailing Address - Country:US
Mailing Address - Phone:305-528-0878
Mailing Address - Fax:
Practice Address - Street 1:1031 IVES DAIRY RD STE 228
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2538
Practice Address - Country:US
Practice Address - Phone:305-528-5914
Practice Address - Fax:305-445-5982
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty