Stanley F Dziedzic, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS 0005577 Issued in FL

Practice address

1155 Malabar Rd NE Ste 10
Palm Bay, FL 32907-3262

Phone

(772) 626-3018

Fax

(321) 723-1771

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

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.

• Palm Bay Urgent Care PL

  • Urgent Care Clinic/Center
  • Palm Bay, FL
  • NPI 1891980389
  Authorized official Same address or phone
• Emergency Medicine Associates Inc

  • Emergency Medicine Physician
  • Vero Beach, FL
  • NPI 1366437386
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1891848370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 MALABAR RD NE STE 10",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329073262",
            "telephone_number": "772-626-3018",
            "fax_number": "321-723-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 MALABAR RD NE STE 10",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329073262",
            "telephone_number": "772-626-3018",
            "fax_number": "321-723-1771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIEDZIC",
        "first_name": "STANLEY",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS 0005577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teauryajya L Dubenion
• Analisa Duncan
• Kaye-Ann Dunkley
• Tauin Durant
• Jared Dykes, APRN
• Kailey Earle
• Lucinda Kathryn Earls, CNA
• Easter Seals Florida, Inc.
• Echelle Inc (Echelle Day Spa)
• Eden's Garden Assisted Living Facility LLC

• Family Medicine Physician in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.