Provider Demographics
NPI:1740764117
Name:PICCOLO, VALERIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:ODELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:46440 BENEDICT DRIVE, SUITE 107
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:703-450-1125
Practice Address - Fax:703-450-1145
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015877490001Medicaid
VA1740764117Medicaid