Healthcare Provider Details

I. General information

NPI: 1033074430
Provider Name (Legal Business Name): CLAUDIA SIMONS YIADOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9823 BRENTSVILLE RD
MANASSAS VA
20112-4531
US

IV. Provider business mailing address

9823 BRENTSVILLE RD
MANASSAS VA
20112-4531
US

V. Phone/Fax

Practice location:
  • Phone: 703-589-0490
  • Fax:
Mailing address:
  • Phone: 703-589-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001227176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: