Provider Demographics
NPI:1275314064
Name:GHAFFARI, SHERINA
Entity Type:Individual
Prefix:
First Name:SHERINA
Middle Name:
Last Name:GHAFFARI
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 1:4413 EAMES LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2632
Mailing Address - Country:US
Mailing Address - Phone:571-343-6374
Mailing Address - Fax:
Practice Address - Street 1:21 STORCK MILL RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-4756
Practice Address - Country:US
Practice Address - Phone:540-356-5979
Practice Address - Fax:540-356-5984
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician