Healthcare Provider Details

I. General information

NPI: 1427527043
Provider Name (Legal Business Name): MIND BODY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 FAIRFAX DR STE 205
ARLINGTON VA
22203-1622
US

IV. Provider business mailing address

4401 FAIRFAX DR STE 205
ARLINGTON VA
22203-1622
US

V. Phone/Fax

Practice location:
  • Phone: 571-328-7408
  • Fax:
Mailing address:
  • Phone: 571-328-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. SAPNA D DOSHI
Title or Position: DIRECTOR
Credential: PHD
Phone: 571-328-7408