Individual
FELICIANO J JUSAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
342 VIRGINIA AVE, WYTHEVILLE, VA 24382-1185
(276) 228-2191
(276) 228-2801
Mailing address
342 VIRGINIA AVE, WYTHEVILLE, VA 24382-1185
(276) 228-2191
(276) 228-2801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101023290
VA
207VG0400X
Gynecology Physician
0101023290
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6247661
—
VA
Enumeration date
01/31/2006
Last updated
09/13/2019
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