MEDICARE: STELLA EKAETTE BASSEY MD

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	2084P0800X	Psychiatry Physician	0101-234154	VA
2	2084P0800X	Psychiatry Physician	0101234154	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821070475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA EKAETTE BASSEY MD

Provider Business Mailing Address
First Line	:	1970 SALEM BLVD
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-6404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 FIRST COLONIAL RD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3078
Country	:	US
Telephone Number	:	757-395-1850
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/14/2024

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