Healthcare Provider Details

I. General information

NPI: 1720750821
Provider Name (Legal Business Name): SYEDA FIZZA FATIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date: 09/15/2026
Reactivation Date: 09/23/2026

III. Provider practice location address

44933 GEORGE WASHINGTON BLVD SUITE 110
ASHBURN VA
20147-6301
US

IV. Provider business mailing address

2600 PARK TOWER DR STE 200
VIENNA VA
22180-7394
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-1818
  • Fax:
Mailing address:
  • Phone: 703-554-7394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005486
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: