Healthcare Provider Details

I. General information

NPI: 1205422680
Provider Name (Legal Business Name): JUMANA FAHEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43300 SOUTHERN WALK PLZ
BROADLANDS VA
20148-4463
US

IV. Provider business mailing address

2715 VELOCITY RD
HERNDON VA
20171-2578
US

V. Phone/Fax

Practice location:
  • Phone: 571-252-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024195393
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: