Healthcare Provider Details

I. General information

NPI: 1851970495
Provider Name (Legal Business Name): SUNDUS K RAZZAQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 OLD GALLOWS RD STE 205
VIENNA VA
22182-3931
US

IV. Provider business mailing address

23149 FLORA MURE DR
ASHBURN VA
20148-7061
US

V. Phone/Fax

Practice location:
  • Phone: 703-403-5413
  • Fax:
Mailing address:
  • Phone: 276-245-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101290763
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: