MEDICARE: NATLYN AJAVON

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1760164388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATLYN AJAVON

Provider Business Mailing Address
First Line	:	2340 CARTA WAY APT 3029
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-6420
Country	:	US
Telephone Number	:	571-268-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	278 CEDAR LN SE # 4080
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-6613
Country	:	US
Telephone Number	:	703-828-5614
Fax Number	:

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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