Healthcare Provider Details

I. General information

NPI: 1003563511
Provider Name (Legal Business Name): OSHETISI JAMILLAH STANNEY CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 STEEPLE ST STE 202-37
MASHPEE MA
02649-3287
US

IV. Provider business mailing address

13 STEEPLE ST STE 202-37
MASHPEE MA
02649-3287
US

V. Phone/Fax

Practice location:
  • Phone: 508-375-7936
  • Fax:
Mailing address:
  • Phone: 508-375-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN05155
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2326428
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0137107TELE
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberTPAN2273
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN71708
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: