Healthcare Provider Details

I. General information

NPI: 1154105856
Provider Name (Legal Business Name): GABRIELLA NICOLE CIFU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST FL 12
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 804-525-0906
  • Fax:
Mailing address:
  • Phone: 804-922-4844
  • Fax: 804-327-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110009390
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110009390
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009390
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: