MEDICARE: DANA HESHAM FAYYAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110-006243	VA

General Provider Information

NPI Number	:	1417434085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA HESHAM FAYYAD

Provider Business Mailing Address
First Line	:	3700 JOSEPH SIEWICK DR STE 308
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-698-8960
Fax Number	:	571-733-9611

Provider Business Practice Location Address
First Line	:	3700 JOSEPH SIEWICK DR STE 308
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-698-8960
Fax Number	:	571-733-9611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	12/13/2018

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Directions to “ DANA HESHAM FAYYAD ” Practice Location

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