Healthcare Provider Details

I. General information

NPI: 1013412436
Provider Name (Legal Business Name): AMY SAFADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LI MD

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR # 900
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

8081 INNOVATION PARK DR # 900
FAIRFAX VA
22031-4867
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4200
  • Fax: 571-472-4190
Mailing address:
  • Phone: 571-472-4200
  • Fax: 571-472-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101274158
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: