Staunton MC 1 LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

STAUNTON MC 1 LLC

Practice address

1775 Tysons Blvd FL 5
MC Lean, VA 22102-4285

Phone

(786) 210-8200

NPI assigned

Feb 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yury Yakubchyk Sr., MD

Title

Medical Director

Phone

(786) 210-8200

Specialties & licenses 1

Addresses

Other names 2

• Elemy Doing business as
• Sprout Therapy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1356975494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 TYSONS BLVD FL 5",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221024285",
            "telephone_number": "786-210-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 TYSONS BLVD FL 5",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221024285",
            "telephone_number": "786-210-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAUNTON MC 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "YAKUBCHYK",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "786-210-8200",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elemy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olivia Stanford
• Whitney Stang-Miller
• Nicole Christine Arielle Star
• Stuart R Stark, M.D.
• Lisa Starr Shorter
• Steadfast Home Care Services, LLC
• Cameron Stearns
• Karin Conley Steele, DPT
• John Paul Steg, MD
• La-Shawna Stegall, RBT

• Behavior Analyst in MC Lean, VA
• Providers in MC Lean, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.