DR. KEVIN JOSEPH STALEY (NPI# 1679512065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679512065 |
| Entity Type | Individual |
| Full Name | DR. KEVIN JOSEPH STALEY |
| Credential | M.D. |
| Practice Address |
55 Fruit Street Wac 708d Boston MA 02114 |
| Mailing Address |
3 Shipway Pl Charlestown MA 02129-4301 |
| Practice Telephone | 6176430363 |
| Practice Fax Number | 6176430141 |
| Mailing Telephone | 6176430363 |
| Mailing Fax Number | 6176430141 |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2012-12-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
230011 | MA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467015420 | Kevin Staley | Behavior Technician | 6624 S 196th St Ste 107, Kent, WA 98032-3113 | 2019-04-16 |
| Street Address |
55 FRUIT STREET WAC 708D |
| City | BOSTON |
| State | MA |
| Zip Code | 02114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407854094 | Adam Scott Landsman | Podiatrist | 55 Fruit Street, Dept. of Orthopaedics/podiatry Service, Boston, MA 02114-2696 | 2005-07-08 |
| 1013532373 | Fei Wu | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Grb444, Boston, MA 02114-2696 | 2020-06-12 |
| 1376163816 | Amine Mohamed Marc Awad | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Internal Medicine Residency Program Manager, Gary Bigel, Boston, MA 02114 | 2020-04-24 |
| 1760011167 | Ellen Clare Mail | Social Worker | 55 Fruit Street, Wacc 023, Boston, MA 02114 | 2020-04-07 |
| 1831726199 | Bennet S Cho | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Grb-425, Boston, MA 02114 | 2020-03-26 |
| 1841827276 | Brian Jacob Kinsman | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Grb444, Boston, MA 02114 | 2020-03-25 |
| 1700413408 | Madhur Nayan | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Boston, MA 02114 | 2020-03-24 |
| 1629605233 | Jimmitti Teysir | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Grb-7-730, Boston, MA 02114 | 2020-03-24 |
| 1841823010 | Mark Wu | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Department of Radiology, Boston, MA 02114-2698 | 2020-02-17 |
| 1831721430 | William Yuanchen Shi | Student in an Organized Health Care Education/Training Program | 55 Fruit Street, Division of Cardiac Surgery, Cox 630, Massachusetts Gen, Boston, MA 02114 | 2020-02-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588276281 | Guoliang Qiao | Student in an Organized Health Care Education/Training Program | Massachusetts General Hospital, 55 Fruit Street., Boston, MA 02114 | 2020-08-24 |
| 1881223741 | Alexander Wesley Zirulnik | Student in an Organized Health Care Education/Training Program | 55 Fruit St. Boston, Boston, MA 02114 | 2020-04-03 |
| 1376170548 | Mia Yu Bothwell | Student in an Organized Health Care Education/Training Program | Gray Bigelow 730, 55 Fruit Street, Boston, MA 02114 | 2020-03-26 |
| 1225661036 | David Dongkyung Kim | Student in an Organized Health Care Education/Training Program | 6 Whittier Place, Apartment 15b, Boston, MA 02114 | 2020-02-20 |
| 1124651658 | Madeleine Sertic | Student in an Organized Health Care Education/Training Program | Division of Abdominal Imaging, Department of Radiology, 55 Fruit Street, White 270, Boston, MA 02114 | 2020-02-12 |
| 1285274498 | Jiuk James Jung | Student in an Organized Health Care Education/Training Program | 15 Parkman Ave, Wang 4-460, Boston, MA 02114 | 2020-01-15 |
| 1831740448 | Jennifer Hughes | Physician Assistant | 55 Fruit Street, Founders 110, Boston, MA 02114 | 2019-09-25 |
| 1558827220 | Aluma Chovel Sella | Student in an Organized Health Care Education/Training Program | Massgeneral Hospital for Children Main Campus, 55 Fruit Street, Boston, MA 02114 | 2019-02-18 |
| 1083187140 | Henry Oliveras | Massage Therapist | 102 Charles Street, Boston, MA 02114 | 2019-01-10 |
| 1720550031 | Nicole M Price | Social Worker | 29 Staniford St, Boston, MA 02114 | 2018-12-27 |
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| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548508252 | Adriana Mendez Sanchez | Psychiatry & Neurology | 771 Albany Street Boston Medical Center Child Neurology, Dowling 3 South Rm 3314, Boston, MA 02118 | 2013-01-30 |
| 1124082714 | Rebeca N Alvareza-altalef | Psychiatry & Neurology | 750 Washington St # 330, Boston, MA 02111-1526 | 2006-04-12 |
| 1982670535 | Elizabeth Anne Thiele | Psychiatry & Neurology | 55 Fruit St Yaw 6b, Pediatric Neurology, Boston, MA 02114 | 2006-02-24 |
| 1205480043 | Lauren Sham | Psychiatry & Neurology | 300 Longwood Ave, Boston, MA 02115-5724 | 2019-07-30 |
| 1386164101 | Ashley Weng | Psychiatry & Neurology | 800 Washington St, Boston, MA 02111 | 2017-06-22 |
| 1891148854 | Jose Ildefonso Rodriguez Moreno | Psychiatry & Neurology | 800 Washington St, Boston, MA 02111-1552 | 2016-07-14 |
| 1245680123 | Sonali Sharma | Psychiatry & Neurology | 800 Washington St, Boston, MA 02111-1552 | 2016-06-21 |
| 1619361672 | Agnieszka Kielian | Psychiatry & Neurology | 300 Longwood Ave, Boston, MA 02115-5724 | 2015-03-26 |
| 1821406232 | Ivan Sanchez Fernandez | Psychiatry & Neurology | 300 Longwood Ave, Boston, MA 02115-5724 | 2014-07-29 |
| 1366860173 | Joshua Tyler August | Psychiatry & Neurology | 1 Boston Medical Ctr Pl, Department of Pediatrics, Dowling 3 South, Boston, MA 02118-2908 | 2014-03-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.