Healthcare Provider Details

I. General information

NPI: 1962861906
Provider Name (Legal Business Name): AISHA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 INNOVATION DR
MANASSAS VA
20110-2214
US

IV. Provider business mailing address

3040 WILLIAMS DR STE 100
FAIRFAX VA
22031-4618
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-8400
  • Fax: 703-940-8692
Mailing address:
  • Phone: 571-350-8400
  • Fax: 571-222-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110010358
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010358
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: