Provider Demographics
NPI:1225027618
Name:DEBRAH-SIRIBOE, STELLA A (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:A
Last Name:DEBRAH-SIRIBOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:633 SUNSET LN
Practice Address - Street 2:SUITE A & C
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3942
Practice Address - Country:US
Practice Address - Phone:540-825-1191
Practice Address - Fax:540-825-0587
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52163208000000X
VA0101051031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000978623DMedicaid