Provider Demographics
NPI:1841376449
Name:SHAFAI, MANDANA (MD)
Entity type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:
Last Name:SHAFAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17336 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3143
Mailing Address - Country:US
Mailing Address - Phone:540-338-3360
Mailing Address - Fax:540-338-1975
Practice Address - Street 1:6862 ELM ST STE 700
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3862
Practice Address - Country:US
Practice Address - Phone:703-288-3750
Practice Address - Fax:703-726-9404
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052152207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG81652Medicare ID - Type Unspecified