Provider Demographics
NPI:1285269589
Name:STANFIELD, TELISSE (CBD, CBC, CPD)
Entity type:Individual
Prefix:
First Name:TELISSE
Middle Name:
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:CBD, CBC, CPD
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 224023
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4023
Mailing Address - Country:US
Mailing Address - Phone:214-984-6882
Mailing Address - Fax:
Practice Address - Street 1:320 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1315
Practice Address - Country:US
Practice Address - Phone:214-984-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
197608OtherSELF