Provider Demographics
NPI:1457537524
Name:BANAIAN, SETAREH (CRNA)
Entity Type:Individual
Prefix:
First Name:SETAREH
Middle Name:
Last Name:BANAIAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 SUNRISE VALLEY DR
Mailing Address - Street 2:APT#302
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1411
Mailing Address - Country:US
Mailing Address - Phone:703-864-4122
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:S-CCC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8556
Practice Address - Fax:202-444-8854
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172809367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00616725OtherRAILROAD MEDICARE
DCP00616725OtherRAILROAD MEDICARE