Healthcare Provider Details

I. General information

NPI: 1649867367
Provider Name (Legal Business Name): ROSHANAK SAFIARDESTANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date: 08/15/2026
Reactivation Date: 08/24/2026

III. Provider practice location address

2235 CEDAR LN STE 102
VIENNA VA
22182-5247
US

IV. Provider business mailing address

2235 CEDAR LN STE 102
VIENNA VA
22182-5247
US

V. Phone/Fax

Practice location:
  • Phone: 703-556-4888
  • Fax:
Mailing address:
  • Phone: 703-556-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: