1407935968 NPI number — MRS. STEPHANIE ANN DIORIO MSPT

Table of content: MRS. STEPHANIE ANN DIORIO MSPT (NPI 1407935968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407935968 NPI number — MRS. STEPHANIE ANN DIORIO MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIORIO
Provider First Name:
STEPHANIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WESOLOWSKI
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407935968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43982 CHELTENHAM CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-4902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-475-8378
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19540 SANDRIDGE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-8286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-475-8378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305205794 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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