Healthcare Provider Details

I. General information

NPI: 1609707488
Provider Name (Legal Business Name): ALLERGY & IMMUNOLOGY VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 FRANKLIN RD SW
ROANOKE VA
24016-5206
US

IV. Provider business mailing address

1505 FRANKLIN RD SW
ROANOKE VA
24016-5206
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-7331
  • Fax:
Mailing address:
  • Phone: 540-343-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSIE MAJNICH
Title or Position: PRACTICE ASSISTANT
Credential:
Phone: 540-343-7331