Provider Demographics
NPI:1306106570
Name:ISMAIL, SAHRA M
Entity type:Individual
Prefix:
First Name:SAHRA
Middle Name:M
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOHAMUD
Other - Middle Name:Y
Other - Last Name:ISMAIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPERATOR
Mailing Address - Street 1:44075 SAXONY TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4923
Mailing Address - Country:US
Mailing Address - Phone:571-308-5892
Mailing Address - Fax:
Practice Address - Street 1:13800 COPPERMINE RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6163
Practice Address - Country:US
Practice Address - Phone:571-308-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-12594374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide