Healthcare Provider Details

I. General information

NPI: 1770645368
Provider Name (Legal Business Name): SWATI SUDHEER SHIRALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 FAIR LAKES PARKWAY
FAIRFAX VA
22033-4512
US

IV. Provider business mailing address

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W KAISER PERMANENTE MID ATL PERM MED GRP PC ATTN T BROOKS
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-934-5905
  • Fax: 703-934-5778
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0074071
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberG081934
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101222017
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: