Healthcare Provider Details

I. General information

NPI: 1770325912
Provider Name (Legal Business Name): SADAF OBAIDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 LEE JACKSON HWY STE 501
FAIRFAX VA
22033-3315
US

IV. Provider business mailing address

PO BOX 45718
BALTIMORE MD
21297-5718
US

V. Phone/Fax

Practice location:
  • Phone: 703-259-7027
  • Fax: 703-591-0005
Mailing address:
  • Phone: 703-259-7027
  • Fax: 703-591-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: