Healthcare Provider Details

I. General information

NPI: 1972566966
Provider Name (Legal Business Name): LATIFAT A HASSAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATIFAT A SHIYANBADE MSN, DNP, FNP

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US DEPARTMENT OF STATE BUREAU OF MEDICAL SERVICES 2401 E ST NW L209
WASHINGTON DC
20520-0001
US

IV. Provider business mailing address

4210 KUALA LUMPUR PL
DULLES VA
20189-4209
US

V. Phone/Fax

Practice location:
  • Phone: 202-736-9044
  • Fax: 202-261-8651
Mailing address:
  • Phone: 240-779-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500019803
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: