1659230605 NPI number — RACHAEL RANEY RILEY SHULTIS 101YP2500X

Table of content: RACHAEL RANEY RILEY SHULTIS 101YP2500X (NPI 1659230605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659230605 NPI number — RACHAEL RANEY RILEY SHULTIS 101YP2500X

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY SHULTIS
Provider First Name:
RACHAEL
Provider Middle Name:
RANEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
101YP2500X
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659230605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1013 LINDEN AVE APT M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22902-9022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-566-9624
Provider Business Mailing Address Fax Number:
804-237-0321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
696 BERKMAR CIR STE 3B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22901-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-566-9624
Provider Business Practice Location Address Fax Number:
804-237-0321
Provider Enumeration Date:
01/16/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701015722 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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