Provider Demographics
NPI:1518000793
Name:SAFDARI, SOHAIL (PA-C)
Entity Type:Individual
Prefix:
First Name:SOHAIL
Middle Name:
Last Name:SAFDARI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 POTOMAC BRANCH DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3337
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8735
Practice Address - Street 1:14605 POTOMAC BRANCH DR STE 300
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3337
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:703-878-8735
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012351363A00000X
VA0110002477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant