Provider Demographics
NPI:1568895514
Name:DASHAWETZ, STANISLAUS (ANP)
Entity Type:Individual
Prefix:MR
First Name:STANISLAUS
Middle Name:
Last Name:DASHAWETZ
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:1 PRISON RD
Mailing Address - City:WOODBOURNE
Mailing Address - State:NY
Mailing Address - Zip Code:12788-1000
Mailing Address - Country:US
Mailing Address - Phone:845-434-7730
Mailing Address - Fax:
Practice Address - Street 1:236 CRAGSMOOR RD
Practice Address - Street 2:
Practice Address - City:CRAGSMOOR
Practice Address - State:NY
Practice Address - Zip Code:12420-0344
Practice Address - Country:US
Practice Address - Phone:845-647-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302769-1364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health