Healthcare Provider Details

I. General information

NPI: 1386454874
Provider Name (Legal Business Name): LYBA KHAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 FORT EVANS RD
LEESBURG VA
20176-3382
US

IV. Provider business mailing address

540 FORT EVANS RD
LEESBURG VA
20176-3382
US

V. Phone/Fax

Practice location:
  • Phone: 703-737-3500
  • Fax:
Mailing address:
  • Phone: 703-737-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011603
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: