Provider Demographics
NPI:1194392191
Name:STAFFORD, DELLA CAY
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:CAY
Last Name:STAFFORD
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:LYNCO
Mailing Address - State:WV
Mailing Address - Zip Code:24857-0021
Mailing Address - Country:US
Mailing Address - Phone:304-682-3008
Mailing Address - Fax:
Practice Address - Street 1:101 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEARFORK
Practice Address - State:WV
Practice Address - Zip Code:24822
Practice Address - Country:US
Practice Address - Phone:304-682-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant