1710561055 NPI number — MS. STEPHANIE RACHAEL DALLOCCHIO PA-C

Table of content: MS. STEPHANIE RACHAEL DALLOCCHIO PA-C (NPI 1710561055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710561055 NPI number — MS. STEPHANIE RACHAEL DALLOCCHIO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALLOCCHIO
Provider First Name:
STEPHANIE
Provider Middle Name:
RACHAEL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1710561055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 WOODMOOR DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONUMENT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80132-9083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-966-1187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2021

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: 363A00000X , with the licence number:  PA.0009068 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 0010-11525 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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