MEDICARE: ASHLEY TAYLOR STACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		VA
2	106E00000X	Assistant Behavior Analyst		VA

General Provider Information

NPI Number	:	1144076555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY TAYLOR STACK

Provider Business Mailing Address
First Line	:	3141 HUNTERS CHASE DR APT 504
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-8035
Country	:	US
Telephone Number	:	757-701-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	4668 PEMBROKE BLVD STE 115
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-416-5290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	01/14/2026

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Practice Location Address:

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Directions to “ ASHLEY TAYLOR STACK ” Practice Location

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