Healthcare Provider Details

I. General information

NPI: 1982178901
Provider Name (Legal Business Name): STEPHANIE ELIZABETH DUVALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 CLEARFIELD AVE STE 300
VIRGINIA BEACH VA
23462-1946
US

IV. Provider business mailing address

225 CLEARFIELD AVE
VIRGINIA BEACH VA
23462-1815
US

V. Phone/Fax

Practice location:
  • Phone: 757-457-5100
  • Fax: 757-961-3696
Mailing address:
  • Phone: 757-457-5100
  • Fax: 757-961-3696

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 State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: