Provider Demographics
NPI:1891848370
Name:DZIEDZIC, STANLEY F (DO)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:F
Last Name:DZIEDZIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MALABAR RD NE STE 10
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3262
Mailing Address - Country:US
Mailing Address - Phone:772-626-3018
Mailing Address - Fax:321-723-1771
Practice Address - Street 1:1155 MALABAR RD NE STE 10
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3262
Practice Address - Country:US
Practice Address - Phone:772-626-3018
Practice Address - Fax:321-723-1771
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 0005577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine