Provider Demographics
NPI:1821542085
Name:NASSAR, LETITIA JOY JUDAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LETITIA
Middle Name:JOY JUDAY
Last Name:NASSAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LETITIA
Other - Middle Name:JOY
Other - Last Name:JUDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-566-3889
Practice Address - Street 1:1111 S JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4724
Practice Address - Country:US
Practice Address - Phone:540-769-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0110005445363A00000X
VA0110005445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant