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NPI Code Detail

MEDICARE: SOFIA SHAHID BRUNDAGE

MEDICARE: SOFIA SHAHID BRUNDAGE
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
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1902415250
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOFIA SHAHID BRUNDAGE
Provider Business Mailing Address
First Line : 7323 ELMWOOD DR
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22042-1409
Country : US
Telephone Number : 571-733-7044
Fax Number :
Provider Business Practice Location Address
First Line : 2800 EISENHOWER AVE STE 200
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22314-5210
Country : US
Telephone Number : 703-562-9220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2020
Last Update Date : 05/01/2026

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Directions to “ SOFIA SHAHID BRUNDAGE ” Practice Location

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