Provider Demographics
NPI:1538838230
Name:NIKZAD FAROKHI, SHIRIN (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRIN
Middle Name:
Last Name:NIKZAD FAROKHI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SHIRIN
Other - Middle Name:
Other - Last Name:NIKZAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42584 DEER ISLE DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3489
Mailing Address - Country:US
Mailing Address - Phone:571-331-3106
Mailing Address - Fax:
Practice Address - Street 1:24801 PINEBROOK RD STE 110
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4113
Practice Address - Country:US
Practice Address - Phone:703-722-2500
Practice Address - Fax:703-327-1850
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000000363LF0000X
VA0024183001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily