Healthcare Provider Details

I. General information

NPI: 1255129037
Provider Name (Legal Business Name): SANA KHADIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N HENRY ST APT 705
ALEXANDRIA VA
22314-2074
US

IV. Provider business mailing address

900 N HENRY ST APT 705
ALEXANDRIA VA
22314-2074
US

V. Phone/Fax

Practice location:
  • Phone: 571-278-8011
  • Fax: 571-278-8011
Mailing address:
  • Phone: 571-278-8011
  • Fax: 571-278-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: