Provider Demographics
NPI:1326862335
Name:TAWAKALYAR, SHAHEDA
Entity type:Individual
Prefix:
First Name:SHAHEDA
Middle Name:
Last Name:TAWAKALYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-8005
Mailing Address - Country:US
Mailing Address - Phone:571-353-0187
Mailing Address - Fax:
Practice Address - Street 1:1881 CAMPUS COMMONS DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1519
Practice Address - Country:US
Practice Address - Phone:703-391-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No171W00000XOther Service ProvidersContractor