MEDICARE: DR. STEPHENIE ASHLEY SCULLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0101250422	VA

General Provider Information

NPI Number	:	1275853756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHENIE ASHLEY SCULLY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	8221 WILLOW OAKS CORPORATE DR STE 4-425
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4512
Country	:	US
Telephone Number	:	703-289-7599
Fax Number	:	703-289-4612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	12/20/2021

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