Provider Demographics
NPI:1225664865
Name:STAINBACK, CHRIS STAINBACK SHEPPARD
Entity Type:Individual
Prefix:
First Name:CHRIS STAINBACK
Middle Name:SHEPPARD
Last Name:STAINBACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2130
Mailing Address - Country:US
Mailing Address - Phone:757-870-6763
Mailing Address - Fax:
Practice Address - Street 1:25 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2130
Practice Address - Country:US
Practice Address - Phone:757-870-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program