Provider Demographics
NPI:1316224009
Name:MADANI, SHAGHAYEGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAGHAYEGH
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525C FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1410
Mailing Address - Country:US
Mailing Address - Phone:703-313-7000
Mailing Address - Fax:703-313-7004
Practice Address - Street 1:6525C FRONTIER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1410
Practice Address - Country:US
Practice Address - Phone:703-313-7000
Practice Address - Fax:703-313-7004
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014133541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice