Individual
MARK SHASTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21351 GENTRY DR STE 125, STERLING, VA 20166-8511
(703) 774-3132
(703) 683-7801
Mailing address
46090 LAKE CENTER PLZ STE 102, STERLING, VA 20165-5877
(703) 774-3132
(703) 683-7801
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101266855
VA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
0101266855
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100527830
—
KY
Enumeration date
04/02/2013
Last updated
05/05/2025
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