Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 0101272316 | VA |
Y | 207KA0200X | Allergist | 0101272316 | VA |
N | 207KA0200X | Allergist | D0091572 | MD |
NPI | 1336501881 |
---|---|
Provider Name | Stefani Su |
First Address | Alexandria, VA 22306-3169 |
Second Address | Alexandria, VA 22306-3169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 14/07/2021 |