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General NPI Number Information
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NPI Number | 1336932482
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Entity Type | Individual
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Provider Name | AZAR MAHDAVI FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 44055 RIVERSIDE PKWY STE 106
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City | LEESBURG
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State | VA
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Zip | 20176-5155
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Country | US
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Telephone | 844-466-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 21250 WINDMILL PARC DR UNIT 104
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City | STERLING
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State | VA
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Zip | 20166-6699
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Country | US
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Telephone | 703-470-7841
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 24193204
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License Number State | VA
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