Healthcare Provider Details

I. General information

NPI: 1124971346
Provider Name (Legal Business Name): STEPHANIE REYES SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3866 RURAL RETREAT RD STE 104
BURLINGTON NC
27215-8462
US

IV. Provider business mailing address

901 CHALICE ST
DURHAM NC
27705-1720
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-4160
  • Fax: 336-890-4164
Mailing address:
  • Phone: 407-520-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number001016061
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: