Provider Demographics
NPI:1851721211
Name:MAHEDAVI, SADIA
Entity Type:Individual
Prefix:
First Name:SADIA
Middle Name:
Last Name:MAHEDAVI
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 1:20573 MIDDLEBURY ST
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7455
Mailing Address - Country:US
Mailing Address - Phone:484-319-2912
Mailing Address - Fax:
Practice Address - Street 1:3400 PAYNE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2313
Practice Address - Country:US
Practice Address - Phone:703-578-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401414129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist