Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0102205840 | VA |
Y | 213ES0000X | Sports Medicine | 0102205840 | VA |
N | 2081S0010X | Sports Medicine | OS017733 | PA |
N | 213ES0000X | Sports Medicine | OS017733 | PA |
NPI | 1497075584 |
---|---|
Provider Name | Dr. Stephanie A Giammittorio |
First Address | Newport News, VA 23601-1318 |
Second Address | Williamsburg, VA 23185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2010 |
Last Update Date | 04/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021855000 | (05) | FL |