MEDICARE: SANDRA M. ZAVALA 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	0024169503	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710275425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA M. ZAVALA FNP

Provider Business Mailing Address
First Line	:	12457 ROSE PATH CIR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-6235
Country	:	US
Telephone Number	:	703-728-3338
Fax Number	:

Provider Business Practice Location Address
First Line	:	9404A MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4032
Country	:	US
Telephone Number	:	571-404-6974
Fax Number	:	571-404-6975

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	05/07/2026

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