Healthcare Provider Details

I. General information

NPI: 1225027618
Provider Name (Legal Business Name): STELLA A. DEBRAH-SIRIBOE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 SUNSET LN SUITE A & C
CULPEPER VA
22701-3942
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-1191
  • Fax: 540-825-0587
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52163
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101051031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: