Provider Demographics
NPI:1881360428
Name:STANLEY, IRENE (PA)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:STANLEY
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Gender:
Credentials:PA
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Mailing Address - Street 1:1411 N. BECKLEY AVE.
Mailing Address - Street 2:PAVILION III SUITE 152
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-948-2076
Mailing Address - Fax:214-948-9990
Practice Address - Street 1:1411 N. BECKLEY AVE.
Practice Address - Street 2:PAVILION III SUITE 152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203
Practice Address - Country:US
Practice Address - Phone:214-948-2076
Practice Address - Fax:214-948-9990
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2025-04-17
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Provider Licenses
StateLicense IDTaxonomies
TXPA17849363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical