Healthcare Provider Details

I. General information

NPI: 1063178671
Provider Name (Legal Business Name): STEFANI LYVETTE DENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 STERNBERG AVE
FORT EUSTIS VA
23604-1527
US

IV. Provider business mailing address

3500 STANCIL ST
VIRGINIA BEACH VA
23452-4208
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7575
  • Fax:
Mailing address:
  • Phone: 757-502-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC007198
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP001178
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001262756
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185090
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: