Provider Demographics
NPI:1356464234
Name:MOTAMEDI, SHAHNAZ (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAHNAZ
Middle Name:
Last Name:MOTAMEDI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DEWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5630
Mailing Address - Country:US
Mailing Address - Phone:703-655-6427
Mailing Address - Fax:
Practice Address - Street 1:1501 DEWBERRY CT
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5630
Practice Address - Country:US
Practice Address - Phone:703-655-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024136965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC10975Medicare UPIN