Provider Demographics
NPI:1164970463
Name:MADANI, SEYEDEH MARYAM
Entity Type:Individual
Prefix:
First Name:SEYEDEH MARYAM
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 EARLSGATE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1608
Mailing Address - Country:US
Mailing Address - Phone:202-769-8689
Mailing Address - Fax:
Practice Address - Street 1:2404 EARLSGATE CT
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1608
Practice Address - Country:US
Practice Address - Phone:202-769-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001265636163W00000X
ZZ311-78094174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163W00000XNursing Service ProvidersRegistered Nurse