Provider Demographics
NPI:1912764846
Name:SIDDIKI, RABELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:RABELLE
Middle Name:
Last Name:SIDDIKI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 ROLAND CLARKE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1445
Mailing Address - Country:US
Mailing Address - Phone:703-435-3366
Mailing Address - Fax:
Practice Address - Street 1:1939 ROLAND CLARKE PL STE 200
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1445
Practice Address - Country:US
Practice Address - Phone:703-435-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily