Healthcare Provider Details

I. General information

NPI: 1578957726
Provider Name (Legal Business Name): YEGANEH JALAEIAN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8296 OLD COURTHOUSE RD STE C
VIENNA VA
22182-3852
US

IV. Provider business mailing address

8296 OLD COURTHOUSE RD STE C
VIENNA VA
22182-3852
US

V. Phone/Fax

Practice location:
  • Phone: 571-200-3284
  • Fax: 571-376-6555
Mailing address:
  • Phone: 571-200-3284
  • Fax: 571-376-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172459
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024172459
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: