Individual
STEPHANIE RENEE MAYRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11204 WAPLES MILL RD, FAIRFAX, VA 22030-6036
(703) 218-8500
(703) 359-0463
Mailing address
11204 WAPLES MILL RD, FAIRFAX, VA 22030-6036
(703) 218-8500
(703) 359-0463
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0101249999
VA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01010249999
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/03/2008
Last updated
11/27/2023
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