Provider Demographics
NPI:1285705145
Name:STASHAK, GERALD THOMAS (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:THOMAS
Last Name:STASHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 GREENWOOD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2451
Mailing Address - Country:US
Mailing Address - Phone:561-832-8886
Mailing Address - Fax:561-832-8802
Practice Address - Street 1:5305 GREENWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2451
Practice Address - Country:US
Practice Address - Phone:561-832-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE61639Medicare UPIN