Provider Demographics
NPI:1912934860
Name:SHIRKHORSHIDI, SHOHREH (FNP)
Entity Type:Individual
Prefix:
First Name:SHOHREH
Middle Name:
Last Name:SHIRKHORSHIDI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21785 FILIGREE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6213
Mailing Address - Country:US
Mailing Address - Phone:703-554-1120
Mailing Address - Fax:703-554-1058
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-554-1120
Practice Address - Fax:703-554-1058
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024109311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
00788N42Medicare PIN
VAQ07348Medicare UPIN
P00234365Medicare PIN