Healthcare Provider Details

I. General information

NPI: 1912764846
Provider Name (Legal Business Name): RABELLE SIDDIKI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 ROLAND CLARKE PL STE 200
RESTON VA
20191-1445
US

IV. Provider business mailing address

1939 ROLAND CLARKE PL STE 200
RESTON VA
20191-1445
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-3366
  • Fax:
Mailing address:
  • Phone: 703-435-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189561
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: