Healthcare Provider Details

I. General information

NPI: 1083541023
Provider Name (Legal Business Name): PETER STASINOS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FOGG RD
WEYMOUTH MA
02190-2432
US

IV. Provider business mailing address

472 EDEN ROC CIR APT 205
VIRGINIA BEACH VA
23451-5497
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number159167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: