Healthcare Provider Details

I. General information

NPI: 1083589634
Provider Name (Legal Business Name): INNOVATIVE SOLUTIONS X LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8480 TYCO RD STE D
VIENNA VA
22182-2247
US

IV. Provider business mailing address

8480 TYCO RD STE D
VIENNA VA
22182-2247
US

V. Phone/Fax

Practice location:
  • Phone: 571-263-2207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: FARID GHANBARI
Title or Position: MANAGER
Credential:
Phone: 571-263-2207