Provider Demographics
NPI:1417045832
Name:VELLA, STACI MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:MARIE
Last Name:VELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 HOLLAND ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGNIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1900
Mailing Address - Country:US
Mailing Address - Phone:757-486-4772
Mailing Address - Fax:757-486-6511
Practice Address - Street 1:4224 HOLLAND ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1900
Practice Address - Country:US
Practice Address - Phone:757-486-4772
Practice Address - Fax:757-486-6511
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
35822OtherMAMSI
1024175OtherAMERICAN SPECIALTY HEALTH
VA330556OtherANTHEM
609393OtherACN
35822OtherMAMSI