Provider Demographics
NPI:1821470725
Name:STANLEY, ANGEL S (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:S
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 ONONDAGA AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1830
Mailing Address - Country:US
Mailing Address - Phone:315-450-7776
Mailing Address - Fax:315-299-6731
Practice Address - Street 1:847 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2504
Practice Address - Country:US
Practice Address - Phone:315-492-1184
Practice Address - Fax:315-474-1554
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401833-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health