Healthcare Provider Details

I. General information

NPI: 1972266484
Provider Name (Legal Business Name): AKUSHERKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 ARLINGTON BLVD
FAIRFAX VA
22031-2906
US

IV. Provider business mailing address

3015 MISSION SQUARE DR
FAIRFAX VA
22031-1112
US

V. Phone/Fax

Practice location:
  • Phone: 703-559-0271
  • Fax:
Mailing address:
  • Phone: 443-545-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATYA SIMON
Title or Position: OWNER
Credential: CNM
Phone: 443-545-9328