Healthcare Provider Details

I. General information

NPI: 1609637198
Provider Name (Legal Business Name): DYNALOT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 LAFAYETTE CENTER DR STE 1300G
CHANTILLY VA
20151-1261
US

IV. Provider business mailing address

4229 LAFAYETTE CENTER DR STE 1300G
CHANTILLY VA
20151-1261
US

V. Phone/Fax

Practice location:
  • Phone: 757-656-9422
  • Fax:
Mailing address:
  • Phone: 757-656-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: VICTOR CHINEDU IRONDI
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 917-660-8557