Healthcare Provider Details

I. General information

NPI: 1326047580
Provider Name (Legal Business Name): TASNEEM A SHAIKH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 BACKLICK RD SUITE 118
SPRINGFIELD VA
22151-3933
US

IV. Provider business mailing address

5252 LYNGATE CT STE 203
BURKE VA
22015-1672
US

V. Phone/Fax

Practice location:
  • Phone: 703-750-1204
  • Fax: 703-750-1206
Mailing address:
  • Phone: 703-239-2300
  • Fax: 703-239-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: