Provider Demographics
NPI:1255823761
Name:DIASTI, NADDA (MA, CCC-SLP, IBCLC)
Entity type:Individual
Prefix:
First Name:NADDA
Middle Name:
Last Name:DIASTI
Suffix:
Gender:F
Credentials:MA, CCC-SLP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 GREENSBORO DR APT 2620
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-7399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 CHURCH ST NE STE 211
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4734
Practice Address - Country:US
Practice Address - Phone:301-615-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000108235Z00000X
MD01670L235Z00000X
DCSLPCF000005235Z00000X
NY03064401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist