Healthcare Provider Details

I. General information

NPI: 1285500181
Provider Name (Legal Business Name): LISA CARULLI STFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

405 JAMES WAY
MARION OH
43302
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-8000
  • Fax:
Mailing address:
  • Phone: 740-751-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: