MEDICARE: DELANDO STEFONZ SMALLWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1033068911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELANDO STEFONZ SMALLWOOD

Provider Business Mailing Address
First Line	:	4200 RUTGERS AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-1342
Country	:	US
Telephone Number	:	757-773-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 RUTGERS AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-1342
Country	:	US
Telephone Number	:	757-773-9198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2026
Last Update Date	:	01/24/2026

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Directions to “ DELANDO STEFONZ SMALLWOOD ” Practice Location

Language	Start Address	Practice Location

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