MEDICARE: MISS VALERIE OPOKU AGYEMAN RD

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	133V00000X	Registered Dietitian	DI200001335	DC
2	133V00000X	Registered Dietitian	DX5150	MD

General Provider Information

NPI Number	:	1548851595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VALERIE OPOKU AGYEMAN RD

Provider Business Mailing Address
First Line	:	11166 FAIRFAX BLVD #1177 STE 500
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5017
Country	:	US
Telephone Number	:	571-547-5729
Fax Number	:

Provider Business Practice Location Address
First Line	:	11166 FAIRFAX BLVD #1177 STE 500
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5017
Country	:	US
Telephone Number	:	571-547-5729
Fax Number	:

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

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	01/12/2026

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