{
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"ParentOrgLBN": null,
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"FirstLineMailingAddress": "13014 WINTER WILLOW DR",
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"MailingAddressStateName": "VA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-200-2945",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14011 WORTH AVE # 120",
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"PracticeLocationAddressTelephoneNumber": "703-686-4505",
"PracticeLocationAddressFaxNumber": "703-686-4502",
"EnumerationDate": "11/16/2024",
"LastUpdateDate": "10/27/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAH",
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"AuthorizedOfficialTelephoneNumber": "703-200-2945",
"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}