Provider Demographics
NPI:1851784714
Name:AHMADI, WAHEEDULLAH (CSA, LSA)
Entity Type:Individual
Prefix:MR
First Name:WAHEEDULLAH
Middle Name:
Last Name:AHMADI
Suffix:
Gender:M
Credentials:CSA, LSA
Other - Prefix:MR
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:408
Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:408
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:816-389-7390
Mailing Address - Fax:
Practice Address - Street 1:3700 JOSEPH SIEWICK DR
Practice Address - Street 2:408
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1744
Practice Address - Country:US
Practice Address - Phone:816-389-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4318246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant