Provider Demographics
NPI:1427621580
Name:AMADOS, MIZPAH (NP)
Entity type:Individual
Prefix:MRS
First Name:MIZPAH
Middle Name:
Last Name:AMADOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16621 RADCLIFFE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4438
Mailing Address - Country:US
Mailing Address - Phone:703-475-9365
Mailing Address - Fax:
Practice Address - Street 1:16621 RADCLIFFE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4438
Practice Address - Country:US
Practice Address - Phone:703-475-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003964363LP0808X
VA0024182292363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024182292OtherLICENSE TO PRACTICE AS A NURSE PRACTITIONER - VALID VIRGINIA ONLY
MDAC003964OtherLICENSE TO PRACTICE AS A NURSE PRACTITIONER - MARYLAND