Provider Demographics
NPI:1902182819
Name:STANLEY, MOIRA DOROTHEA (PA-C)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:DOROTHEA
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 STATE ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4859
Mailing Address - Country:US
Mailing Address - Phone:732-776-4770
Mailing Address - Fax:732-776-3763
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4770
Practice Address - Fax:732-776-3763
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00269400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical