Healthcare Provider Details

I. General information

NPI: 1982016663
Provider Name (Legal Business Name): VANESSA ALIA EMDADI BANKS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 210
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2232
  • Fax: 540-536-2206
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102205024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: