Healthcare Provider Details

I. General information

NPI: 1417894379
Provider Name (Legal Business Name): CHRISTIANA STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ALWIN ST
HYDE PARK MA
02136-1218
US

IV. Provider business mailing address

42 ALWIN ST
HYDE PARK MA
02136-1218
US

V. Phone/Fax

Practice location:
  • Phone: 617-401-1795
  • Fax:
Mailing address:
  • Phone: 617-401-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN61148
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: