Provider Demographics
NPI:1225785744
Name:FALLAVOLLITA, DAVID (DNAP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FALLAVOLLITA
Suffix:
Gender:M
Credentials:DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 NORTHUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENSON
Mailing Address - State:VA
Mailing Address - Zip Code:22656-1999
Mailing Address - Country:US
Mailing Address - Phone:703-309-8422
Mailing Address - Fax:
Practice Address - Street 1:7277 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1739
Practice Address - Country:US
Practice Address - Phone:703-309-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001267539163W00000X
VA0024186496367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse