MEDICARE: STEPHANIE REYES SOTO

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	261QU0200X	Urgent Care Clinic/Center	001016061	NC
2	363A00000X	Physician Assistant	0010-16061	NC

General Provider Information

NPI Number	:	1124971346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REYES SOTO

Provider Business Mailing Address
First Line	:	901 CHALICE ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-1720
Country	:	US
Telephone Number	:	407-520-0966
Fax Number	:

Provider Business Practice Location Address
First Line	:	3866 RURAL RETREAT RD STE 104
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8462
Country	:	US
Telephone Number	:	336-890-4160
Fax Number	:	336-890-4164

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	05/27/2026

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