Healthcare Provider Details

I. General information

NPI: 1508541343
Provider Name (Legal Business Name): VENITA LYNN CUCURELLA SMITH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN CUCURELLA

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9161 LIBERIA AVE STE 400A
MANASSAS VA
20110-1727
US

IV. Provider business mailing address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 844-333-8411
  • Fax: 833-464-2578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: