Provider Demographics
NPI:1649548801
Name:HERRERA, NADIA PERITSALIS (PA)
Entity type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:PERITSALIS
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 H ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2728
Mailing Address - Country:US
Mailing Address - Phone:251-610-4139
Mailing Address - Fax:
Practice Address - Street 1:6849 OLD DOMINION DR STE 450
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3718
Practice Address - Country:US
Practice Address - Phone:703-356-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-585363AM0700X
VA0110-007100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical