Healthcare Provider Details

I. General information

NPI: 1942237425
Provider Name (Legal Business Name): STEPHANIE ANN RIOLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 2ND ST SUITE 2000
DAYTON OH
45402-1372
US

IV. Provider business mailing address

1001 E 2ND ST SUITE 2000
DAYTON OH
45402-1372
US

V. Phone/Fax

Practice location:
  • Phone: 937-607-1710
  • Fax:
Mailing address:
  • Phone: 937-607-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35087779
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301077485
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: