Healthcare Provider Details

I. General information

NPI: 1801885025
Provider Name (Legal Business Name): DANIEL SEVERO SEVILLA APA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

7515 IRENE CT
SPRINGFIELD VA
22153-1700
US

V. Phone/Fax

Practice location:
  • Phone: 703-454-7570
  • Fax: 703-704-0437
Mailing address:
  • Phone: 703-454-7570
  • Fax: 703-704-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: