Healthcare Provider Details

I. General information

NPI: 1629935754
Provider Name (Legal Business Name): MARIA T MBINKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 HAVERHILL RD
STAFFORD VA
22554-7389
US

IV. Provider business mailing address

1619 HAVERHILL RD
STAFFORD VA
22554-7389
US

V. Phone/Fax

Practice location:
  • Phone: 703-401-0640
  • Fax: --
Mailing address:
  • Phone: 703-401-0640
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number500339999
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number500339999
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: