Provider Demographics
NPI:1649209842
Name:STANESCU, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:STANESCU
Suffix:
Gender:F
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 C-300
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4162
Mailing Address - Country:US
Mailing Address - Phone:904-808-7246
Mailing Address - Fax:904-808-7090
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C-300
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4162
Practice Address - Country:US
Practice Address - Phone:904-808-7246
Practice Address - Fax:904-808-7090
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76186207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254957300Medicaid
FL44445OtherBCBS PROVIDER NUMBER
FL37189OtherGROUP MEDICARE NUMBER
FL7308803OtherAETNA PROVIDER NUMBER
FL44445OtherBCBS PROVIDER NUMBER
FL44445AMedicare ID - Type Unspecified