Healthcare Provider Details

I. General information

NPI: 1508421660
Provider Name (Legal Business Name): HEATHER STANLEY-CHRISTIAN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17323 PAGONIA DR STE 227
CLERMONT FL
34711-5997
US

IV. Provider business mailing address

17323 PAGONIA DR STE 227
CLERMONT FL
34711-5997
US

V. Phone/Fax

Practice location:
  • Phone: 352-404-5544
  • Fax: 352-404-5912
Mailing address:
  • Phone: 352-404-5544
  • Fax: 352-404-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER STANLEY-CHRISTIAN
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: MD
Phone: 352-404-5544