Provider Demographics
NPI:1336932482
Name:MAHDAVI, AZAR (FNP-BC)
Entity type:Individual
Prefix:
First Name:AZAR
Middle Name:
Last Name:MAHDAVI
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 1:21250 WINDMILL PARC DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6699
Mailing Address - Country:US
Mailing Address - Phone:703-470-7841
Mailing Address - Fax:
Practice Address - Street 1:44055 RIVERSIDE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5155
Practice Address - Country:US
Practice Address - Phone:844-466-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24193204363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner