Healthcare Provider Details

I. General information

NPI: 1871901645
Provider Name (Legal Business Name): ANAHITA AMINSHOKRAVI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 PINE ST
HERNDON VA
20170-4604
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 703-471-7810
  • Fax: 703-471-6549
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002358
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: