Provider Demographics
NPI:1578299475
Name:STANEK, EWELINA WERONIKA (PA-C)
Entity type:Individual
Prefix:
First Name:EWELINA
Middle Name:WERONIKA
Last Name:STANEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2361
Mailing Address - Country:US
Mailing Address - Phone:561-642-1000
Mailing Address - Fax:
Practice Address - Street 1:5964 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7788
Practice Address - Country:US
Practice Address - Phone:469-495-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116209363A00000X
TXPA18243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant