Healthcare Provider Details

I. General information

NPI: 1427900240
Provider Name (Legal Business Name): CONCUSSION AND HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44075 PIPELINE PLZ STE 300
ASHBURN VA
20147-5889
US

IV. Provider business mailing address

12603 BUILDERS RD
HERNDON VA
20170-2924
US

V. Phone/Fax

Practice location:
  • Phone: 703-996-9186
  • Fax: 844-751-2064
Mailing address:
  • Phone: 703-864-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER A BAEZ
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 703-864-9988