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General NPI Number Information
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NPI Number | 1750388971
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Entity Type | Individual
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Provider Name | AVA CHERYL STANCZAK D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 645 E STATE HIGHWAY 121 STE 600
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City | COPPELL
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State | TX
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Zip | 75019-7942
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Country | US
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Telephone | 972-745-7500
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Fax | 972-745-4336
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Provider Business Mailing Address
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Address Line | 432 FARRIS MINES RD
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City | ALLISONIA
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State | VA
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Zip | 24347-4072
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Country | US
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Telephone | 540-230-4668
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01022011441
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G4785
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License Number State | TX
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