Provider Demographics
NPI:1275853756
Name:SCULLY, STEPHENIE ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHENIE
Middle Name:ASHLEY
Last Name:SCULLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:STEPHENIE
Other - Middle Name:ASHLEY
Other - Last Name:BOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR STE 4-425
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:703-289-7599
Practice Address - Fax:703-289-4612
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012504222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry