Provider Demographics
NPI:1427693894
Name:MISSAGHI, LEYLA (PA-C)
Entity type:Individual
Prefix:
First Name:LEYLA
Middle Name:
Last Name:MISSAGHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-280-9596
Practice Address - Street 1:8613 ROUTE 29 STE 100N
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2172
Practice Address - Country:US
Practice Address - Phone:571-350-8400
Practice Address - Fax:703-280-9596
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110006952363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant