Provider Demographics
NPI:1932463684
Name:WALDEN, STANLEY
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:WALDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14134 CASTLE BLVD
Mailing Address - Street 2:APT 404
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4630
Mailing Address - Country:US
Mailing Address - Phone:240-705-5266
Mailing Address - Fax:
Practice Address - Street 1:14134 CASTLE BLVD
Practice Address - Street 2:APT 404
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4630
Practice Address - Country:US
Practice Address - Phone:240-705-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide