Provider Demographics
NPI:1164831350
Name:STANISLAS, AMOS (MD)
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:
Last Name:STANISLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 NW 56TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2587
Mailing Address - Country:US
Mailing Address - Phone:305-987-1327
Mailing Address - Fax:
Practice Address - Street 1:4301 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6749
Practice Address - Country:US
Practice Address - Phone:305-987-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
FLME163714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No282N00000XHospitalsGeneral Acute Care Hospital