Provider Demographics
NPI:1275830192
Name:ASSEFAW, ALMAZ
Entity Type:Individual
Prefix:MISS
First Name:ALMAZ
Middle Name:
Last Name:ASSEFAW
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 1:6128 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1016
Mailing Address - Country:US
Mailing Address - Phone:202-818-8656
Mailing Address - Fax:
Practice Address - Street 1:12007 SUNRISE VALLEY DR STE 300
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3446
Practice Address - Country:US
Practice Address - Phone:804-207-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004657364SP0808X, 363LP0808X
VA0024169575363LP0808X, 363LF0000X
DCCN-1100338363LF0000X
MARN2336612363LF0000X
DCRN961903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily