Healthcare Provider Details

I. General information

NPI: 1356860829
Provider Name (Legal Business Name): NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W BROAD ST STE 214
FALLS CHURCH VA
22046
US

IV. Provider business mailing address

1881 N NASH ST UNIT 309
ARLINGTON VA
22209-1563
US

V. Phone/Fax

Practice location:
  • Phone: 571-332-5757
  • Fax:
Mailing address:
  • Phone: 571-332-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number0101051081
License Number StateVA

VIII. Authorized Official

Name: DR. SHEILA JAHAN
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 571-332-5757