Healthcare Provider Details

I. General information

NPI: 1881504017
Provider Name (Legal Business Name): MRS. SHAMIMARA HAQUE SIDDIQUEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24560 SOUTHPOINT DR STE 260
ALDIE VA
20105-3505
US

IV. Provider business mailing address

21140 TWINRIDGE SQ
STERLING VA
20164-6315
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-7472
  • Fax:
Mailing address:
  • Phone: 703-895-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: