Ava Cheryl Stanczak, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G4785 Issued in TX

Practice address

645 E State Highway 121 Ste 600
Coppell, TX 75019-7942

Phone

(972) 745-7500

Fax

(972) 745-4336

NPI assigned

Jul 1, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Lincoln Memorial University

  dba LMU Dental Clinic

  • Dental Clinic/Center
  • Knoxville, TN
  • NPI 1992985865
  NPD

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1750388971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 FARRIS MINES RD",
            "city": "ALLISONIA",
            "state": "VA",
            "postal_code": "243474072",
            "telephone_number": "540-230-4668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 E STATE HIGHWAY 121 STE 600",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750197942",
            "telephone_number": "972-745-7500",
            "fax_number": "972-745-4336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "165 Westmoreland St",
            "address_purpose": "LOCATION",
            "city": "Harrogate",
            "state": "TN",
            "postal_code": "377528202",
            "country_code": "US",
            "telephone_number": "423-869-7193",
            "fax_number": "423-869-7195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANCZAK",
        "first_name": "AVA",
        "middle_name": "CHERYL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "01022011441",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "G4785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102201441",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sparks Healthcare Services Inc
• Spooner Physical Therapy & Hand Rehab, PC (Spooner Coppell)
• Lori B Spors
• Meagan Taylor Springer, DPT
• Brittany Spruiell, DDS
• Breunha Stapleton
• Star Dermatology PLLC
• Star Health & Rehab PA
• Star Health & Rehab, PA
• Star Neuro PLLC

• Pediatrics Physician in Coppell, TX
• Providers in Coppell, TX by specialty
• Pediatrics Physician in Texas

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

Verify at the official NPI Registry.