Healthcare Provider Details

I. General information

NPI: 1093292153
Provider Name (Legal Business Name): SARAH DAWN FAGGERT DAC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 CHAIN BRIDGE RD STE 101
MC LEAN VA
22101-5728
US

IV. Provider business mailing address

11017 BYRD DR
FAIRFAX VA
22030-5331
US

V. Phone/Fax

Practice location:
  • Phone: 571-354-6643
  • Fax:
Mailing address:
  • Phone: 804-955-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: