Healthcare Provider Details

I. General information

NPI: 1932720117
Provider Name (Legal Business Name): STEPHANIE MARIE SPINA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 LANGHORNE RD STE 405
LYNCHBURG VA
24501-1423
US

IV. Provider business mailing address

300 BEVERLY HILLS CIR
LYNCHBURG VA
24502-4106
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3933
  • Fax:
Mailing address:
  • Phone: 205-913-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007074
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: