Organization Active NPI

Stanley a Cohen DO PA

  • Psychiatry Physician
  • St Augustine, FL
National Provider Identifier
1285809012
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
OS7389 Issued in FL
Legal business name
STANLEY A COHEN DO PA
Practice address
605 Palencia Club Dr # 201
St Augustine, FL 32095-6901
Phone
(904) 808-8595
Fax
(904) 808-8596
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shanan Moore
Title
Practice Manager
Phone
(904) 808-8595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X OS7389 FL Primary

Addresses

Primary practice location

605 Palencia Club Dr # 201
St Augustine, FL 32095-6901

Mailing address

605 Palencia Club Dr # 201
St Augustine, FL 32095-6901
Phone (904) 808-8595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081009000674 FL Part B Supplier - Clinic/Group Practice 3173691698 Receives reassigned benefits from 4 practitioners
Practice locations: St Augustine, FL

National Provider Directory

National Provider Directory

Locations

605 Palencia Club Dr
Ste 201
Saint Augustine, FL 32095
Phone (904) 808-8595

605 Palencia Club Dr
#201
Saint Augustine, FL 32095
Phone (904) 808-8595

354 Paseo Reyes Dr
St Augustine, FL 32095
Phone (904) 755-6592

605 Palencia Club Dr
Ste 201
St Augustine, FL 32095

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1285809012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 PALENCIA CLUB DR # 201",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320956901",
            "telephone_number": "904-808-8595",
            "fax_number": "904-808-8596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 PALENCIA CLUB DR # 201",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320956901",
            "telephone_number": "904-808-8595",
            "fax_number": "904-808-8596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANLEY A COHEN DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "SHANAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "904-808-8595"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "OS7389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.