MEDICARE: STEPHEN BEASLEY

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1437792769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN BEASLEY

Provider Business Mailing Address
First Line	:	2621 TARLETON CORNER DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-4497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4638 H ST SE APT 205
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-4987
Country	:	US
Telephone Number	:	571-888-2506
Fax Number	:

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

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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Directions to “ STEPHEN BEASLEY ” Practice Location

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