Provider Demographics
NPI:1457437584
Name:COHEN, STANLEY A (DOPA)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:COHEN
Suffix:
Gender:M
Credentials:DOPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PALENCIA CLUB DR # 201
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6901
Mailing Address - Country:US
Mailing Address - Phone:904-808-8595
Mailing Address - Fax:904-808-8596
Practice Address - Street 1:605 PALENCIA CLUB DR # 201
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-6901
Practice Address - Country:US
Practice Address - Phone:904-808-8595
Practice Address - Fax:904-808-8596
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS73892084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57469ZMedicare ID - Type Unspecified