Provider Demographics
NPI:1720511421
Name:KANAK, SHAIMA JALALA (DNP,FNP)
Entity Type:Individual
Prefix:
First Name:SHAIMA
Middle Name:JALALA
Last Name:KANAK
Suffix:
Gender:F
Credentials:DNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8988 LORTON STATION BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4758
Practice Address - Country:US
Practice Address - Phone:703-339-7550
Practice Address - Fax:703-339-7553
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily