1275589053 NPI number — MS. SARAH ROXANNE STANLEY PA-C

Table of content: MS. SARAH ROXANNE STANLEY PA-C (NPI 1275589053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275589053 NPI number — MS. SARAH ROXANNE STANLEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANLEY
Provider First Name:
SARAH
Provider Middle Name:
ROXANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275589053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 MANNING DRIVE, CB 7235
Provider Second Line Business Mailing Address:
DEPT. OF UROLOGY, 2113 PHYSICIAN'S OFFICE BUILDING
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
849-974-1315
Provider Business Mailing Address Fax Number:
919-966-0098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF UROLOGY 2113 PHYSICIANS OFFICE
Provider Second Line Business Practice Location Address:
170 MANNING DR., CB 7235
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-2586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-966-2574
Provider Business Practice Location Address Fax Number:
919-966-0098
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  001000340 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 0010-00340 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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