Provider Demographics
NPI:1972837391
Name:JADALI, AMNA NASAR (PAC)
Entity type:Individual
Prefix:MS
First Name:AMNA
Middle Name:NASAR
Last Name:JADALI
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:AMNA
Other - Middle Name:NASAR
Other - Last Name:IQBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19490 SANDRIDGE WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3467
Mailing Address - Country:US
Mailing Address - Phone:631-383-1014
Mailing Address - Fax:
Practice Address - Street 1:550 BROADVIEW AVE STE 102
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2036
Practice Address - Country:US
Practice Address - Phone:540-680-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05186363A00000X
NY23 013606363A00000X
DCPA030879363A00000X
VA0110004039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972837391Medicaid
VA30015494130001Medicaid