Provider Demographics
NPI:1851463236
Name:STANIS, PAMELA (PNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:STANIS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3930
Mailing Address - Country:US
Mailing Address - Phone:201-801-9209
Mailing Address - Fax:201-287-9627
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:JACOBI MEDICAL CENTER PED ER FOLLOW UP BLDG6 RM1D-03
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381296363LP0200X
NJ26NN05927600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics