Healthcare Provider Details

I. General information

NPI: 1437656139
Provider Name (Legal Business Name): ALLYSHAH M ALLAHDINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALI M ALLAHDINA MD

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ELDEN ST STE 100
HERNDON VA
20170-4834
US

IV. Provider business mailing address

1855 W TAYLOR ST
CHICAGO IL
60612-7242
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-2020
  • Fax: 703-563-3769
Mailing address:
  • Phone: 312-996-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.160167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: