Individual
MRS. SHABNAM PROPHET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-6000
Mailing address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-005674
VA
Other
Enumeration date
02/15/2017
Last updated
01/23/2020
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