MEDICARE: IRINA STANASEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	P5735	TX
2	2088P0231X	Pediatric Urology Physician	MD2015-0175	NM

General Provider Information

NPI Number	:	1942460191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA STANASEL

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-9257
Country	:	US
Telephone Number	:	214-648-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-1740
Country	:	US
Telephone Number	:	214-648-3111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	10/30/2019

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Directions to “ IRINA STANASEL ” Practice Location

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