Provider Demographics
NPI:1790074581
Name:STANTON, AUDRA ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:ROCHELLE
Last Name:STANTON
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 1:402 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-2300
Mailing Address - Country:US
Mailing Address - Phone:724-799-7455
Mailing Address - Fax:
Practice Address - Street 1:402 HIDDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-2300
Practice Address - Country:US
Practice Address - Phone:724-799-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1224102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry