Provider Demographics
NPI:1649739608
Name:MOSHREFI, SHOLEH
Entity Type:Individual
Prefix:
First Name:SHOLEH
Middle Name:
Last Name:MOSHREFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35757 PLATINUM DR
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-3523
Mailing Address - Country:US
Mailing Address - Phone:703-599-6572
Mailing Address - Fax:
Practice Address - Street 1:35757 PLATINUM DR
Practice Address - Street 2:
Practice Address - City:ROUND HILL
Practice Address - State:VA
Practice Address - Zip Code:20141-3523
Practice Address - Country:US
Practice Address - Phone:703-599-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCI-191982163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health