Healthcare Provider Details

I. General information

NPI: 1386006567
Provider Name (Legal Business Name): ALEXANDRA JADE STANLEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 STANFORD BLVD
COLUMBIA MD
21045-5805
US

IV. Provider business mailing address

8930 STANFORD BLVD
COLUMBIA MD
21045-5805
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-3358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR201206
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR201206
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: