Provider Demographics
NPI:1578572905
Name:SUTTERFIELD, JULIANN (MPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIANN
Middle Name:
Last Name:SUTTERFIELD
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 COLUMBUS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6725
Mailing Address - Country:US
Mailing Address - Phone:414-736-1317
Mailing Address - Fax:757-965-6843
Practice Address - Street 1:6160 KEMPSVILLE CIRCLE
Practice Address - Street 2:SMITHFIELD BLDG. SUITE 102A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2910
Practice Address - Country:US
Practice Address - Phone:757-461-8300
Practice Address - Fax:757-461-8967
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001136363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP32875Medicare UPIN
P32875Medicare UPIN
VA970000498Medicare ID - Type UnspecifiedPROVIDER #