Provider Demographics
NPI:1306857552
Name:SABET, HAIDEH YAZDANI (MD)
Entity Type:Individual
Prefix:DR
First Name:HAIDEH
Middle Name:YAZDANI
Last Name:SABET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5130 DUKE ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2955
Mailing Address - Country:US
Mailing Address - Phone:703-370-9411
Mailing Address - Fax:703-370-9417
Practice Address - Street 1:5130 DUKE ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2955
Practice Address - Country:US
Practice Address - Phone:703-370-9411
Practice Address - Fax:703-370-9417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010111528Medicaid
VAG01494N01Medicare ID - Type Unspecified
VA010111528Medicaid