Healthcare Provider Details

I. General information

NPI: 1962004853
Provider Name (Legal Business Name): FAHIMEH MEIDANI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/15/2020
Certification Date: 11/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8519 TUTTLE RD STE 208
SPRINGFIELD VA
22152-1508
US

IV. Provider business mailing address

3874 LYNDHURST DR APT 201
FAIRFAX VA
22031-3723
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-8041
  • Fax:
Mailing address:
  • Phone: 571-278-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: