Healthcare Provider Details

I. General information

NPI: 1821806779
Provider Name (Legal Business Name): MAHELET ADGO YALEW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6299 LEESBURG PIKE
FALLS CHURCH VA
22044-2101
US

IV. Provider business mailing address

6101 EDSALL RD APT 306
ALEXANDRIA VA
22304-6002
US

V. Phone/Fax

Practice location:
  • Phone: 571-569-6543
  • Fax:
Mailing address:
  • Phone: 571-426-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: