Healthcare Provider Details

I. General information

NPI: 1396689287
Provider Name (Legal Business Name): PAUL WASSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 ALLERTON CT APT 302
DUMFRIES VA
22026-3217
US

IV. Provider business mailing address

3451 ALLERTON CT APT 302
DUMFRIES VA
22026-3217
US

V. Phone/Fax

Practice location:
  • Phone: 240-762-9602
  • Fax: 540-930-7529
Mailing address:
  • Phone: 240-762-9602
  • Fax: 540-930-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: