Provider Demographics
NPI:1073318556
Name:SOOR, JAYOTI
Entity type:Individual
Prefix:DR
First Name:JAYOTI
Middle Name:
Last Name:SOOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E FAIRFAX ST APT 507
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2909
Mailing Address - Country:US
Mailing Address - Phone:703-419-0311
Mailing Address - Fax:
Practice Address - Street 1:21351 GENTRY DR STE 200
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8512
Practice Address - Country:US
Practice Address - Phone:703-493-0891
Practice Address - Fax:703-552-1948
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0805002634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist