Healthcare Provider Details

I. General information

NPI: 1477472892
Provider Name (Legal Business Name): AZZA KHATTAB HASSAN AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 CAPITAL CT STE 108
MANASSAS VA
20110-2049
US

IV. Provider business mailing address

9720 CAPITAL CT STE 108
MANASSAS VA
20110-2049
US

V. Phone/Fax

Practice location:
  • Phone: 703-678-6473
  • Fax: 703-748-2212
Mailing address:
  • Phone: 703-678-6473
  • Fax: 703-748-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-428838
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: