Healthcare Provider Details

I. General information

NPI: 1053208116
Provider Name (Legal Business Name): SHAHID AFZAAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 NIGHTINGALE HILL LANE SUITE 404
ALEXANDRIA VA
22306-3099
US

IV. Provider business mailing address

7230 NIGHTINGALE HILL LANE SUITE 404
ALEXANDRIA VA
22306-3099
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-1329
  • Fax:
Mailing address:
  • Phone: 703-717-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: