Healthcare Provider Details

I. General information

NPI: 1568114080
Provider Name (Legal Business Name): ZAKIA NAZIMA SERAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 LYNDHURST DR APT 202
FAIRFAX VA
22031-3729
US

IV. Provider business mailing address

3790 LYNDHURST DR APT 202
FAIRFAX VA
22031-3729
US

V. Phone/Fax

Practice location:
  • Phone: 517-974-3181
  • Fax:
Mailing address:
  • Phone: 517-974-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: