Provider Demographics
NPI:1306238308
Name:YANNITELLO, ASHLYN NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:NICOLE
Last Name:YANNITELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:NICOLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:24952 PEACH RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5750
Mailing Address - Country:US
Mailing Address - Phone:757-291-6747
Mailing Address - Fax:
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031110363AM0700X
MDC06570363AM0700X
CAPA60333363AM0700X
NC0010-11837363AM0700X
FLTPPA236363AM0700X
WVITRPA-1004363AM0700X
AZTP8786363AM0700X
VA0110004812363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical