Healthcare Provider Details

I. General information

NPI: 1235558982
Provider Name (Legal Business Name): JESSICA NOELLE SOSA-STANLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 625
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-526-1550
  • Fax: 540-526-1383
Mailing address:
  • Phone: 540-224-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD464258
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101269071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: