1538838230 NPI number — MRS. SHIRIN NIKZAD FAROKHI FNP

Table of content: MRS. SHIRIN NIKZAD FAROKHI FNP (NPI 1538838230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538838230 NPI number — MRS. SHIRIN NIKZAD FAROKHI FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIKZAD FAROKHI
Provider First Name:
SHIRIN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIKZAD
Provider Other First Name:
SHIRIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538838230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42584 DEER ISLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20152-3489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-331-3106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24801 PINEBROOK RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANTILLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20152-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-722-2500
Provider Business Practice Location Address Fax Number:
703-327-1850
Provider Enumeration Date:
09/07/2021

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: 363LF0000X , with the licence number:  00000000 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024183001 , 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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