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General NPI Number Information
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NPI Number | 1093370348
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Entity Type | Individual
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Provider Name | STEPHANIE PETRUZZO
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 19450 DEERFIELD AVENUE, SUITE 325
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City | LEESBURG
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State | VA
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Zip | 20176-8503
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Country | US
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Telephone | 571-252-8119
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Fax | 800-735-1643
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL ST., NW SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-007018
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License Number State | VA
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