Provider Demographics
NPI:1720750821
Name:FATIMA, SYEDA FIZZA
Entity Type:Individual
Prefix:
First Name:SYEDA FIZZA
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21173 BOSTON TERRACE
Mailing Address - Street 2:APT 208
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166
Mailing Address - Country:US
Mailing Address - Phone:703-554-7394
Mailing Address - Fax:
Practice Address - Street 1:44933 GEORGE WASHINGTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6301
Practice Address - Country:US
Practice Address - Phone:844-244-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral