Healthcare Provider Details

I. General information

NPI: 1083342596
Provider Name (Legal Business Name): PERSONIC NEUROPSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 LITTLE RIVER TPKE STE 101W
ANNANDALE VA
22003-2611
US

IV. Provider business mailing address

7611 LITTLE RIVER TPKE STE 101W
ANNANDALE VA
22003-2611
US

V. Phone/Fax

Practice location:
  • Phone: 571-556-9777
  • Fax: 215-933-6837
Mailing address:
  • Phone: 803-220-2234
  • Fax: 215-933-6837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SYED NAQVI
Title or Position: OWNER
Credential: DO
Phone: 803-220-2234