MEDICARE: MS. STEPHANIE RACHAEL DALLOCCHIO PA-C

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	363A00000X	Physician Assistant	PA.0009068	CO
2	363A00000X	Physician Assistant	0010-11525	NC

General Provider Information

NPI Number	:	1710561055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE RACHAEL DALLOCCHIO PA-C

Provider Business Mailing Address
First Line	:	1840 WOODMOOR DR STE 102
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9083
Country	:	US
Telephone Number	:	719-966-1187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 WOODMOOR DR STE 102
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9083
Country	:	US
Telephone Number	:	719-966-1187
Fax Number	:

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	10/14/2025

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