Active NPI
Susan Tavakoli
- Athletic Trainer
- Fairfax, VA
National Provider Identifier
1134760564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 3046 Mission Square Dr
Fairfax, VA 22031-1113 - Phone
- (757) 334-4514
- NPI assigned
- Oct 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202216060 | VA | |
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
3046 Mission Square Dr
Fairfax, VA 22031-1113
Mailing address
3046 Mission Square Dr
Fairfax, VA 22031-1113
Phone (757) 334-4514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202216060 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570406400000",
"number": "1134760564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3046 MISSION SQUARE DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220311113",
"telephone_number": "757-334-4514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3046 MISSION SQUARE DR",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220311113",
"telephone_number": "757-334-4514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVAKOLI",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-07",
"last_updated": "2019-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202216060",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.