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:
Health care specialties
Specialty | Code | License # | 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 last year |
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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1417919408 | NPPES |
Virginia | MEDICAID | 30015904250001 | |
Virginia | Other | 0110002171 | |
Virginia | MEDICAID | 1417919408 |
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