Healthcare Provider Details

I. General information

NPI: 1780168724
Provider Name (Legal Business Name): ALEXANDRIA JOZY FLAHERTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 ROUTE 29 STE 200N
FAIRFAX VA
22031-2171
US

IV. Provider business mailing address

3040 WILLIAMS DR STE 100
FAIRFAX VA
22031-4618
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-8400
  • Fax: 703-280-9596
Mailing address:
  • Phone: 703-280-3963
  • Fax: 703-280-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010861
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110010861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: