Healthcare Provider Details

I. General information

NPI: 1346348992
Provider Name (Legal Business Name): TSEDAY EYASU SIRAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TSEDAY EYASU SIRAK MD

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S CARLIN SPRINGS RD STE 402
ARLINGTON VA
22204-1087
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 703-592-6141
  • Fax:
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101242816
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number51585
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: