Provider Demographics
NPI:1033681036
Name:CAPUTO, STACEY
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 MANASSAS CIR
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3090
Mailing Address - Country:US
Mailing Address - Phone:540-797-0117
Mailing Address - Fax:
Practice Address - Street 1:2149 ELECTRIC RD STE 3
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1975
Practice Address - Country:US
Practice Address - Phone:540-797-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist