Healthcare Provider Details

I. General information

NPI: 1801466685
Provider Name (Legal Business Name): HELENA EZZELDIN MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date: 01/21/2022
Reactivation Date: 02/16/2022

III. Provider practice location address

2 CARDINAL PARK DR. SE, STE. 104A
LEESBURG VA
20175
US

IV. Provider business mailing address

11707 SUMMERCHASE CIR APT E
RESTON VA
20194-1129
US

V. Phone/Fax

Practice location:
  • Phone: 571-291-0693
  • Fax:
Mailing address:
  • Phone: 571-291-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: