Provider Demographics
NPI:1063414167
Name:STANSKI, CHERYL (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:STANSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 4A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-392-6265
Practice Address - Fax:423-392-6272
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 35333208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010100771Medicaid
TN3864805Medicaid
TN3864805Medicare ID - Type Unspecified
TN020049485Medicare PIN
TN3864805Medicaid
0281780003Medicare PIN
0281780001Medicare PIN
VA010100771Medicaid
TN3700592Medicare UPIN
H39140Medicare UPIN
TNCA5023Medicare PIN