Healthcare Provider Details

I. General information

NPI: 1659995173
Provider Name (Legal Business Name): HYSA COGNITIVE AND NEUROREHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 CENTREVILLE RD # J17-734
HERNDON VA
20171-4586
US

IV. Provider business mailing address

2465 CENTREVILLE RD # J17-734
HERNDON VA
20171-4586
US

V. Phone/Fax

Practice location:
  • Phone: 586-873-1094
  • Fax:
Mailing address:
  • Phone: 586-873-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: VIOLA QAFALIJAJ HYSA
Title or Position: PRESIDENT
Credential: MD
Phone: 586-873-1094