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NPI Code Detail

MEDICARE: STAUNTON MC 1 LLC

MEDICARE: STAUNTON MC 1 LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1356975494
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAUNTON MC 1 LLC
Provider Business Mailing Address
First Line : 1775 TYSONS BLVD FL 5
Second Line :
City : MC LEAN
State : VA
Zip : 22102-4285
Country : US
Telephone Number : 786-210-8200
Fax Number :
Provider Business Practice Location Address
First Line : 1775 TYSONS BLVD FL 5
Second Line :
City : MC LEAN
State : VA
Zip : 22102-4285
Country : US
Telephone Number : 786-210-8200
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : YURY YAKUBCHYK SR.
Credential : MD
Telephone Number : 786-210-8200
Provider Enumeration Date : 02/27/2020
Last Update Date : 09/27/2021

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Directions to “STAUNTON MC 1 LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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