Healthcare Provider Details

I. General information

NPI: 1689211054
Provider Name (Legal Business Name): ASHRAF SEFAIN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 01/23/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 ROSEHAVEN ST STE 100
FAIRFAX VA
22030-2877
US

IV. Provider business mailing address

10521 ROSEHAVEN ST STE 100
FAIRFAX VA
22030-2877
US

V. Phone/Fax

Practice location:
  • Phone: 703-650-0636
  • Fax:
Mailing address:
  • Phone: 703-650-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024189284
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: