Provider Demographics
NPI:1629490172
Name:AYYAS, SHADI (MD)
Entity type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:AYYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 DAKOTA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2969
Mailing Address - Country:US
Mailing Address - Phone:202-766-3019
Mailing Address - Fax:540-465-3202
Practice Address - Street 1:44050 ASHBURN SHOPPING PLZ STE 179
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7916
Practice Address - Country:US
Practice Address - Phone:202-766-3019
Practice Address - Fax:540-338-1975
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255466207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine