Provider Demographics
NPI:1659032571
Name:VEDOVA, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VEDOVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 SUNSET VIEW TER SE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-6186
Mailing Address - Country:US
Mailing Address - Phone:703-304-6260
Mailing Address - Fax:
Practice Address - Street 1:10713 OLDFIELD DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5215
Practice Address - Country:US
Practice Address - Phone:703-582-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst