Healthcare Provider Details

I. General information

NPI: 1598260127
Provider Name (Legal Business Name): ANDREW M.F.L. ABDELSAYED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 PUBLIX WAY STE 120
STAFFORD VA
22554-7783
US

IV. Provider business mailing address

2101 DOGWOOD DR APT 205
FREDERICKSBURG VA
22401-8903
US

V. Phone/Fax

Practice location:
  • Phone: 347-463-5447
  • Fax:
Mailing address:
  • Phone: 347-463-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416514
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: