Healthcare Provider Details

I. General information

NPI: 1770571861
Provider Name (Legal Business Name): SYLVIA DEBRONGER MEBANE-BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 HUNTER PL STE 101
WOODBRIDGE VA
22192-3938
US

IV. Provider business mailing address

2510 HUNTER PL STE 101
WOODBRIDGE VA
22192-3938
US

V. Phone/Fax

Practice location:
  • Phone: 571-316-1069
  • Fax: 571-402-7907
Mailing address:
  • Phone: 571-316-1069
  • Fax: 571-402-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21721
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185730
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: