Healthcare Provider Details

I. General information

NPI: 1710275425
Provider Name (Legal Business Name): SANDRA M. ZAVALA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9404A MAIN ST
FAIRFAX VA
22031-4032
US

IV. Provider business mailing address

12457 ROSE PATH CIR
FAIRFAX VA
22033-6235
US

V. Phone/Fax

Practice location:
  • Phone: 571-404-6974
  • Fax: 571-404-6975
Mailing address:
  • Phone: 703-728-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: