Provider Demographics
NPI:1598385999
Name:BEHSUDI, AMIR M (CPHT, EMT-B)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:M
Last Name:BEHSUDI
Suffix:
Gender:M
Credentials:CPHT, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7805 KAREN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2424
Mailing Address - Country:US
Mailing Address - Phone:202-716-3056
Mailing Address - Fax:
Practice Address - Street 1:14390 CHANTILLY CROSSING LN
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2117
Practice Address - Country:US
Practice Address - Phone:703-885-5546
Practice Address - Fax:703-885-5564
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDT19720183700000X
VAB202104096146N00000X
DCPT00936183700000X
VA0230031906183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic