Healthcare Provider Details

I. General information

NPI: 1649658709
Provider Name (Legal Business Name): AISHA MONDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2015
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N QUINCY ST STE 620
ARLINGTON VA
22203-1999
US

IV. Provider business mailing address

1215 LEE ST BOX #801210
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 703-812-4642
  • Fax: 703-812-7926
Mailing address:
  • Phone: 434-924-5314
  • Fax: 434-243-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0086002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: