MEDICARE: MRS. SHIRIN NIKZAD FAROKHI FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024183001	VA

General Provider Information

NPI Number	:	1538838230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRIN NIKZAD FAROKHI FNP

Provider Business Mailing Address
First Line	:	42584 DEER ISLE DR
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-3489
Country	:	US
Telephone Number	:	571-331-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	24801 PINEBROOK RD STE 110
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-722-2500
Fax Number	:	703-327-1850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	05/07/2026

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