Provider Demographics
NPI:1316748627
Name:SHULTS, STEPHANIE (BSN, CDCES)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SHULTS
Suffix:
Gender:
Credentials:BSN, CDCES
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, CMSRN
Mailing Address - Street 1:2215 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5226
Mailing Address - Country:US
Mailing Address - Phone:615-713-9549
Mailing Address - Fax:
Practice Address - Street 1:16337 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:VA
Practice Address - Zip Code:22514-2105
Practice Address - Country:US
Practice Address - Phone:615-713-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA32308345163WD0400X
VA1121781163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator