Provider Demographics
NPI:1972960201
Name:DURRANI, AYEFA SALEEM
Entity Type:Individual
Prefix:
First Name:AYEFA
Middle Name:SALEEM
Last Name:DURRANI
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 1:162 LAUREL WAY
Mailing Address - Street 2:APT 2A
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4427
Mailing Address - Country:US
Mailing Address - Phone:203-638-4341
Mailing Address - Fax:
Practice Address - Street 1:504 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4741
Practice Address - Country:US
Practice Address - Phone:703-464-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014143781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice