Healthcare Provider Details

I. General information

NPI: 1871957035
Provider Name (Legal Business Name): SALINA KHUSHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 12/11/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 HAMAKER CT STE 600
FAIRFAX VA
22031-2241
US

IV. Provider business mailing address

3023 HAMAKER CT STE 600
FAIRFAX VA
22031-2241
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-2788
  • Fax: 703-839-8764
Mailing address:
  • Phone: 703-876-2788
  • Fax: 703-839-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number0101274723
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: