Provider Demographics
NPI:1760164388
Name:AJAVON, NATLYN
Entity Type:Individual
Prefix:
First Name:NATLYN
Middle Name:
Last Name:AJAVON
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 1:2340 CARTA WAY APT 3029
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6420
Mailing Address - Country:US
Mailing Address - Phone:571-268-7804
Mailing Address - Fax:
Practice Address - Street 1:278 CEDAR LN SE # 4080
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6613
Practice Address - Country:US
Practice Address - Phone:703-828-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency