Provider Demographics
NPI:1114031713
Name:HEGAZI, SHIRINE I (DC)
Entity Type:Individual
Prefix:DR
First Name:SHIRINE
Middle Name:I
Last Name:HEGAZI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 OLD LEE HWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4323
Mailing Address - Country:US
Mailing Address - Phone:202-309-1653
Mailing Address - Fax:
Practice Address - Street 1:2826 OLD LEE HWY
Practice Address - Street 2:SUITE 350
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:202-309-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor