Provider Demographics
NPI:1710561055
Name:DALLOCCHIO, STEPHANIE RACHAEL (PA-C)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RACHAEL
Last Name:DALLOCCHIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 WOODMOOR DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9083
Mailing Address - Country:US
Mailing Address - Phone:719-966-1187
Mailing Address - Fax:
Practice Address - Street 1:1840 WOODMOOR DR STE 102
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9083
Practice Address - Country:US
Practice Address - Phone:719-966-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0009068363A00000X
NC0010-11525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant