Provider Demographics
NPI:1376581645
Name:FITZGERALD, ANUSHAYA MISRA (PAC)
Entity type:Individual
Prefix:
First Name:ANUSHAYA
Middle Name:MISRA
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANOO
Other - Middle Name:SHAYA
Other - Last Name:MISRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL STREET, NW, STE 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 1:19450 DEERFIELD AVENUE, SUITE 200
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6821
Practice Address - Country:US
Practice Address - Phone:571-209-1875
Practice Address - Fax:703-777-3365
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008955301Medicaid
VA1376581645Medicaid
VA30016705640002Medicaid
VA008955301Medicaid