Healthcare Provider Details

I. General information

NPI: 1013733245
Provider Name (Legal Business Name): TAYYABA SHAHID KHAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41618 FENWAY CIRCLE
ASHBURN VA
20148
US

IV. Provider business mailing address

6840 BEN FRANKLIN RD
SPRINGFIELD VA
22150-3036
US

V. Phone/Fax

Practice location:
  • Phone: 571-550-5144
  • Fax:
Mailing address:
  • Phone: 571-550-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191912
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: