Healthcare Provider Details

I. General information

NPI: 1982049565
Provider Name (Legal Business Name): NEHA P KASABWALA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3600
  • Fax: 703-391-3414
Mailing address:
  • Phone: 703-391-3600
  • Fax: 703-391-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024170784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: