Basic Information
| Provider Information | |||||||||
| NPI: | 1649209842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANESCU | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 SOUTHPARK BLVD | ||||||||
| Address2: | SUITE C-300 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320864162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048087246 | ||||||||
| FaxNumber: | 9048087090 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 SOUTHPARK BLVD | ||||||||
| Address2: | SUITE C-300 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320864162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048087246 | ||||||||
| FaxNumber: | 9048087090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 11/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | ME76186 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 254957300 | 05 | FL | MEDICAID | 44445 | 01 | FL | BCBS PROVIDER NUMBER | OTHER | 37189 | 01 | FL | GROUP MEDICARE NUMBER | OTHER | 7308803 | 01 | FL | AETNA PROVIDER NUMBER | OTHER |