Healthcare Provider Details

I. General information

NPI: 1780593566
Provider Name (Legal Business Name): IRODA YASSAWY LC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

17980 SWANS CREEK LN
DUMFRIES VA
22026-4526
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-7864
  • Fax:
Mailing address:
  • Phone: 703-597-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-311019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: