Healthcare Provider Details

I. General information

NPI: 1457171001
Provider Name (Legal Business Name): STEFANIE DEL RIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 09/29/2026
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VICAR PL
DANVILLE VA
24540-1241
US

IV. Provider business mailing address

4820 WHITMELL SCHOOL RD
DRY FORK VA
24549-2346
US

V. Phone/Fax

Practice location:
  • Phone: 434-272-8372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: