Healthcare Provider Details

I. General information

NPI: 1316748627
Provider Name (Legal Business Name): STEPHANIE SHULTS BSN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE BENSON BSN, CMSRN

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16337 ANTIOCH RD
MILFORD VA
22514-2105
US

IV. Provider business mailing address

2215 PLANK RD
FREDERICKSBURG VA
22401-5226
US

V. Phone/Fax

Practice location:
  • Phone: 615-713-9549
  • Fax:
Mailing address:
  • Phone: 615-713-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number32308345
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1121781
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: