Healthcare Provider Details

I. General information

NPI: 1770671166
Provider Name (Legal Business Name): SWAPNA SIVAMONY DEV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 WAPLES MILL RD
FAIRFAX VA
22030-7406
US

IV. Provider business mailing address

11211 WAPLES MILL RD
FAIRFAX VA
22030-7406
US

V. Phone/Fax

Practice location:
  • Phone: 703-592-4600
  • Fax:
Mailing address:
  • Phone: 703-592-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101240115
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: