Provider Demographics
NPI:1114728995
Name:MCCORMACK, AUGUSTA DANIELLA
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:DANIELLA
Last Name:MCCORMACK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 TAZANARI WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5357
Mailing Address - Country:US
Mailing Address - Phone:202-330-2735
Mailing Address - Fax:
Practice Address - Street 1:13105 TAZANARI WAY APT 303
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5357
Practice Address - Country:US
Practice Address - Phone:202-330-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health