Individual
MS. STEPHANIE L MODZELESKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
19450 DEERFIELD AVE STE 200, LEESBURG, VA 20176-6821
(571) 209-1875
(703) 777-3365
Mailing address
224-D CORNWALL ST., NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002171
VA
363AS0400X
Surgical Physician Assistant
0110002171
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110002171
LICENSE
VA
05
—
1417919408
—
VA
05
—
30015904250001
—
VA
Enumeration date
04/05/2006
Last updated
02/07/2026
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