Healthcare Provider Details

I. General information

NPI: 1023879129
Provider Name (Legal Business Name): ASHLEY DISTEFANO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MCCLELLAND ND

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

IV. Provider business mailing address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

V. Phone/Fax

Practice location:
  • Phone: 480-770-5337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: