Provider Demographics
NPI:1801226121
Name:SHMATOV, LINDSAY (FNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:SHMATOV
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 WALKER LN STE 311
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3258
Mailing Address - Country:US
Mailing Address - Phone:703-822-0222
Mailing Address - Fax:
Practice Address - Street 1:6355 WALKER LN STE 311
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3258
Practice Address - Country:US
Practice Address - Phone:703-822-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner