Provider Demographics
NPI:1669500245
Name:ELTAYEB, HUSHAM SAYED
Entity Type:Individual
Prefix:MR
First Name:HUSHAM
Middle Name:SAYED
Last Name:ELTAYEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 BEAUREGARD STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312
Mailing Address - Country:US
Mailing Address - Phone:202-330-8995
Mailing Address - Fax:703-256-7222
Practice Address - Street 1:5133 BEAUREGARD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1929
Practice Address - Country:US
Practice Address - Phone:202-330-8995
Practice Address - Fax:703-256-7222
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)