Individual
DR. STANLEY IDICULLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
112 ELDEN ST, SUITE D, HERNDON, VA 20170-4874
(703) 437-5353
Mailing address
112 ELDEN ST, SUITE D, HERNDON, VA 20170-4874
(703) 437-5353
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
XXXX
VA
Other
Enumeration date
04/13/2006
Last updated
12/18/2013
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