MEDICARE: STEPHANIE REID

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	172A00000X	Driver

General Provider Information

NPI Number	:	1568129377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REID

Provider Business Mailing Address
First Line	:	5128 LAKEVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5128 LAKEVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2030
Country	:	US
Telephone Number	:	704-761-9690
Fax Number	:

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

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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Directions to “ STEPHANIE REID ” Practice Location

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