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General NPI Number Information
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NPI Number | 1093705444
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Entity Type | Individual
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Provider Name | STANLEY R STANSELL PA
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 397 LITTLE NECK RD STE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5764
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Country | US
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Telephone | 757-470-5570
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Fax | 757-961-9359
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Provider Business Mailing Address
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Address Line | 397 LITTLE NECK RD STE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5764
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Country | US
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Telephone | 757-470-5576
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Fax | 757-961-9359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110001891
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0101279
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License Number State | NC
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