Healthcare Provider Details

I. General information

NPI: 1306171145
Provider Name (Legal Business Name): NANAH SHERIFF SESAY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANAH SHERIFF SESAY FNP-BC

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OPTIZ BLVD
WOODBRIDGE VA
22191
US

IV. Provider business mailing address

7331 CRESTLEIGH CIRCLE
ALEXANDRIA VA
22315
US

V. Phone/Fax

Practice location:
  • Phone: 703-523-1000
  • Fax: 703-354-4919
Mailing address:
  • Phone: 571-277-3500
  • Fax: 703-354-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168060
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC0002940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: