Healthcare Provider Details

I. General information

NPI: 1023540176
Provider Name (Legal Business Name): STUTI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46000 CENTER OAK PLZ # 260
STERLING VA
20166-8538
US

IV. Provider business mailing address

44045 RIVERSIDE PKWY
LEESBURG VA
20176-5101
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-6464
  • Fax:
Mailing address:
  • Phone: 703-858-6000
  • Fax: 703-858-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101278067
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: