Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101247305 | VA |
N | 207QS0010X | Family Doctor - Sports Medicine | 0101247305 | VA |
NPI | 1073716635 |
---|---|
Provider Name | Siobhan M. Statuta |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22903-1767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 13/10/2020 |