=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912874314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVA MJ HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8296 OLD COURTHOUSE RD STE C
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-200-3284
-----------------------------------------------------
Fax | 571-376-6555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8296 OLD COURTHOUSE RD STE C
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-200-3284
-----------------------------------------------------
Fax | 571-376-6555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP
-----------------------------------------------------
Name | DR. YEGANEH JALAEIAN
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 571-200-3284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------