Provider Demographics
NPI:1902481708
Name:BASTIANELLI, RACHEL VAUGHAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:VAUGHAN
Last Name:BASTIANELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-6410
Mailing Address - Country:US
Mailing Address - Phone:703-647-6087
Mailing Address - Fax:
Practice Address - Street 1:6311 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-6410
Practice Address - Country:US
Practice Address - Phone:703-647-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant