Healthcare Provider Details

I. General information

NPI: 1609787712
Provider Name (Legal Business Name): FXR FOOT & ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 FAIR LAKES CIR STE 110C
FAIRFAX VA
22033-4904
US

IV. Provider business mailing address

PO BOX 220158
CHANTILLY VA
20153-0158
US

V. Phone/Fax

Practice location:
  • Phone: 703-291-8834
  • Fax:
Mailing address:
  • Phone: 703-291-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SHYAUN RAFII
Title or Position: OWNER
Credential: DPM
Phone: 703-291-8834