Provider Demographics
NPI:1972837391
Name:JADALI, AMNA NASAR (PAC)
Entity Type:Individual
Prefix:MS
First Name:AMNA
Middle Name:NASAR
Last Name:JADALI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AMNA
Other - Middle Name:NASAR
Other - Last Name:IQBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:19490 SANDRIDGE WAY, SUITE 210
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3467
Practice Address - Country:US
Practice Address - Phone:703-723-7504
Practice Address - Fax:703-723-7550
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004039363A00000X
MDC05186363A00000X
NY23 013606363A00000X
DCPA030879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972837391Medicaid
VA30015494130001Medicaid