Healthcare Provider Details

I. General information

NPI: 1467194266
Provider Name (Legal Business Name): PAYMON SADROLSADOT ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 402
WASHINGTON DC
20015-2055
US

IV. Provider business mailing address

1530 SPRING GATE DR UNIT 9314
MC LEAN VA
22102-3421
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-7000
  • Fax:
Mailing address:
  • Phone: 571-532-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP2000102
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: