Provider Demographics
NPI:1316712268
Name:STANIC, ANDRIJA VALE II
Entity type:Individual
Prefix:
First Name:ANDRIJA
Middle Name:VALE
Last Name:STANIC
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 SE 2ND AVE APT 151
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5524
Mailing Address - Country:US
Mailing Address - Phone:954-600-9952
Mailing Address - Fax:
Practice Address - Street 1:959 SE 2ND AVE APT 151
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5524
Practice Address - Country:US
Practice Address - Phone:954-600-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46020390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program