MEDICARE: SARAH ELYSE STOLLE

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	103K00000X	Behavior Analyst	0133000700	VA

General Provider Information

NPI Number	:	1659730208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELYSE STOLLE

Provider Business Mailing Address
First Line	:	700 DWYER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-6921
Country	:	US
Telephone Number	:	757-615-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 DWYER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-6921
Country	:	US
Telephone Number	:	757-615-3003
Fax Number	:	757-243-1262

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	04/22/2022

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