Provider Demographics
NPI:1396435137
Name:BUSHRA, NAFEESA
Entity type:Individual
Prefix:
First Name:NAFEESA
Middle Name:
Last Name:BUSHRA
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 1:2621 PROMENADE PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4905
Mailing Address - Country:US
Mailing Address - Phone:804-592-6877
Mailing Address - Fax:804-251-0714
Practice Address - Street 1:2621 PROMENADE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4905
Practice Address - Country:US
Practice Address - Phone:804-592-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000481103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst