Individual provider Active NPI

Stella Antony, DNP, PMHNP-BC.

  • Psychiatric/Mental Health Nurse Practitioner
  • Fremont, CA
National Provider Identifier
1417529769
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95029333 Issued in CA
Practice address
39001 Sundale Dr
Fremont, CA 94538-2005
Phone
(510) 796-1100
NPI assigned
Jul 15, 2021
Last updated
Mar 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95088551 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95029333 CA Primary

Addresses

Primary practice location

39001 Sundale Dr
Fremont, CA 94538-2005

Mailing address

39001 Sundale Dr
Fremont, CA 94538-2005
Phone (510) 796-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251117000849 CA Practitioner - Nurse Practitioner 7113418336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 789
Danville, CA 94526

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95088551CAMDRegistered Nurse
95029333CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Medical Group CurrentSince Sep 5, 2025 Accepting new patients
California Behavior Solutions Inc CurrentSince Sep 5, 2025 Accepting new patients

Locations

39001 Sundale Dr
Fremont, CA 94538
Phone (510) 796-1100

91 Gregory Ln
Ste 20
Pleasant Hill, CA 94523
Phone (925) 813-9273

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1417529769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39001 SUNDALE DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382005",
            "telephone_number": "510-796-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39001 SUNDALE DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382005",
            "telephone_number": "510-796-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONY",
        "first_name": "STELLA",
        "credential": "DNP, PMHNP-BC.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95088551",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95029333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.