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General NPI Number Information
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NPI Number | 1326760497
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Entity Type | Organization
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Legal Business Name | PERSONA PAYMENTS LLC
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1953 GALLOWS RD STE 120
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City | TYSONS CORNER
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State | VA
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Zip | 22182-4009
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Country | US
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Telephone | 703-291-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 8120 WOODMONT AVE STE 180
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City | BETHESDA
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State | MD
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Zip | 20814-2757
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Country | US
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Telephone | 703-405-5338
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KAVAN SHABAN
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Credential |
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Telephone | 703-405-5338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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