Provider Demographics
NPI:1215311808
Name:BANAEI, YASMIN
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:BANAEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:POURKAZEMI
Other - Last Name:BANAEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:416 FLORIDA AVE NW UNIT 26484
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-0519
Mailing Address - Country:US
Mailing Address - Phone:202-681-0594
Mailing Address - Fax:628-209-5692
Practice Address - Street 1:46175 WESTLAKE DR STE 110
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5873
Practice Address - Country:US
Practice Address - Phone:202-681-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0486152084P0800X
MDD00903282084P0800X
VA01012707442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry