1417961756 NPI number — DR. SARAH LISBETH SIRBASKU WILLIAMS PH.D.

Table of content: DR. SARAH LISBETH SIRBASKU WILLIAMS PH.D. (NPI 1417961756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417961756 NPI number — DR. SARAH LISBETH SIRBASKU WILLIAMS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIRBASKU WILLIAMS
Provider First Name:
SARAH
Provider Middle Name:
LISBETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIRBASKU
Provider Other First Name:
SARAH
Provider Other Middle Name:
LISBETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417961756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1069 W BROAD ST
Provider Second Line Business Mailing Address:
SUITE 249
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22046-4610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-766-8717
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1604 SPRING HILL RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22182-7510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-766-8717
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810004728 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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