Healthcare Provider Details

I. General information

NPI: 1679493167
Provider Name (Legal Business Name): AMY O'CONNOR CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 RIVERSIDE PKWY
LEESBURG VA
20176-5101
US

IV. Provider business mailing address

5715 CASTLE HILL DR
INDIANAPOLIS IN
46250-5606
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136001172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: