Healthcare Provider Details

I. General information

NPI: 1588722847
Provider Name (Legal Business Name): KATHERINE HOLLY SIKORYAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 RICHMOND HWY #415
ALEXANDRIA VA
22309-2300
US

IV. Provider business mailing address

8350 RICHMOND HWY #415
ALEXANDRIA VA
22309-2300
US

V. Phone/Fax

Practice location:
  • Phone: 703-704-6346
  • Fax: 703-704-6687
Mailing address:
  • Phone: 703-704-6346
  • Fax: 703-704-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0040183
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD038500
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101045471
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: