MEDICARE: SHAWAL TARIQ NP

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	363L00000X	Nurse Practitioner	0024194298	VA

General Provider Information

NPI Number	:	1811649627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWAL TARIQ NP

Provider Business Mailing Address
First Line	:	4400 UNIVERSITY DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-4422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 ASHTON AVE STE 200
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20109-5688
Country	:	US
Telephone Number	:	571-581-1771
Fax Number	:	571-358-3941

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

Provider Enumeration Date	:	01/23/2022
Last Update Date	:	12/09/2025

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