Healthcare Provider Details

I. General information

NPI: 1184465189
Provider Name (Legal Business Name): CHRISTY ENYINNAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5695 KING CENTRE DR STE 303
ALEXANDRIA VA
22315-5748
US

IV. Provider business mailing address

15212 CHULA PL
WOODBRIDGE VA
22193-5860
US

V. Phone/Fax

Practice location:
  • Phone: 571-200-6222
  • Fax:
Mailing address:
  • Phone: 703-587-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number0024189378
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: