Healthcare Provider Details

I. General information

NPI: 1285257428
Provider Name (Legal Business Name): MARIYAM SHEIDU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44035 RIVERSIDE PKWY STE 400
LEESBURG VA
20176-8260
US

IV. Provider business mailing address

2901 TELESTAR CT STE 300
FALLS CHURCH VA
22042-1263
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-5421
  • Fax: 703-858-9573
Mailing address:
  • Phone: 703-591-1688
  • Fax: 703-591-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0116033840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: