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General NPI Number Information
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NPI Number | 1255823761
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Entity Type | Individual
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Provider Name | NADDA DIASTI MA, CCC-SLP, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 501 CHURCH ST NE STE 211
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City | VIENNA
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State | VA
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Zip | 22180-4734
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Country | US
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Telephone | 301-615-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 8305 GREENSBORO DR APT 2620
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City | MC LEAN
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State | VA
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Zip | 22102-7399
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2204000108
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License Number State | VA
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