Active NPI
Jayda Charlene Stanley, LMT
- Massage Therapist
- Brockton, MA
National Provider Identifier
1619715901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17148
- Practice address
- 74 Plain St Ste D
Brockton, MA 02301-7162 - Phone
- (610) 291-9948
- Fax
- (610) 291-9948
- NPI assigned
- Jul 19, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 17148 | MA | Primary |
Addresses
Primary practice location
74 Plain St Ste D
Brockton, MA 02301-7162
Mailing address
180 Main St Apt F135
Bridgewater, MA 02324-1467
Phone (610) 291-9948
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17148 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721347200000",
"number": "1619715901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 MAIN ST APT F135",
"city": "BRIDGEWATER",
"state": "MA",
"postal_code": "023241467",
"telephone_number": "610-291-9948",
"fax_number": "610-291-9948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 PLAIN ST STE D",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017162",
"telephone_number": "610-291-9948",
"fax_number": "610-291-9948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "JAYDA",
"middle_name": "CHARLENE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-19",
"last_updated": "2024-07-19",
"certification_date": "2024-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MA",
"license": "17148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.