Healthcare Provider Details

I. General information

NPI: 1487900056
Provider Name (Legal Business Name): SHEEBA MAHNAZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 FAIRFAX BLVD
FAIRFAX VA
22030-2000
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 703-679-1876
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101262132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: