Healthcare Provider Details

I. General information

NPI: 1346583846
Provider Name (Legal Business Name): SHIRIN MARYAH DALAI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4876 BAXTER RD. FIRST CHOICE MEDICAL CARE
VIRGINIA BEACH VA
23462
US

IV. Provider business mailing address

4876 BAXTER RD. FIRST CHOICE MEDICAL CARE
VIRGINIA BEACH VA
23462
US

V. Phone/Fax

Practice location:
  • Phone: 757-671-7777
  • Fax: 757-671-7778
Mailing address:
  • Phone: 757-671-7777
  • Fax: 757-671-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001204321
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170759
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: