Healthcare Provider Details

I. General information

NPI: 1023237997
Provider Name (Legal Business Name): SHAWANA MUFTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR, SUITE 60
FAIRFAX VA
22030-2917
US

IV. Provider business mailing address

3930 PENDER DR STE 60
FAIRFAX VA
22030-0991
US

V. Phone/Fax

Practice location:
  • Phone: 703-539-8987
  • Fax: 703-865-4167
Mailing address:
  • Phone: 703-539-8987
  • Fax: 703-865-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101241302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: