Healthcare Provider Details

I. General information

NPI: 1649755745
Provider Name (Legal Business Name): MIRIAN SILVA NAYBOR CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRIAN CRISTINA DA SILVA

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5614 FLAG RUN DR
SPRINGFIELD VA
22151-2725
US

IV. Provider business mailing address

5614 FLAG RUN DR
SPRINGFIELD VA
22151-2725
US

V. Phone/Fax

Practice location:
  • Phone: 301-448-6801
  • Fax:
Mailing address:
  • Phone: 301-448-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30049861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: