Healthcare Provider Details

I. General information

NPI: 1134940554
Provider Name (Legal Business Name): GHAZANFAR ALI SHEIKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23297 SOUTHDOWN MANOR TER UNIT 104
ASHBURN VA
20148-8149
US

IV. Provider business mailing address

23297 SOUTHDOWN MANOR TER UNIT 104
ASHBURN VA
20148-8149
US

V. Phone/Fax

Practice location:
  • Phone: 571-363-5640
  • Fax:
Mailing address:
  • Phone: 571-363-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number123273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: