Provider Demographics
NPI:1942902754
Name:STANLEY, SHADONAE JANELLE
Entity Type:Individual
Prefix:
First Name:SHADONAE
Middle Name:JANELLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N ARLINGTON AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4232
Mailing Address - Country:US
Mailing Address - Phone:347-755-4811
Mailing Address - Fax:
Practice Address - Street 1:132 N ARLINGTON AVE APT 305
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4232
Practice Address - Country:US
Practice Address - Phone:347-755-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06883600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker