Modzelesky, Stephanie L

Modzelesky, Stephanie L is an individual health care provider with primary practice located at 224-D Cornwall Street Nw, Suite 204 , Leesburg VA 20176-2700. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Modzelesky, Stephanie L can be contacted via phone (571) 209-1875.

Contact Information

Primary practice address
224-D Cornwall Street Nw, Suite 204 Leesburg VA 20176-2700
Phone: (571) 209-1875
Fax: (703) 777-3365
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 0110002171 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110002171 Virginia

Profile Details

NPI number 1417919408
LBN Legal business name Modzelesky, Stephanie L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2006
Last updated Mar 6th, 2024 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417919408 NPPES
Virginia MEDICAID 30015904250001
Virginia Other 0110002171
Virginia MEDICAID 1417919408

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