Blair Katherine Simonetti, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110003695 Issued in VA

Practice address

1831 Wiehle Ave
Reston, VA 20190

Phone

(703) 709-1114

Fax

(703) 709-1117

NPI assigned

Oct 13, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Blair Katherine Snyder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532563200000",
    "number": "1548545296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 SUNRISE VALLEY DR STE 800",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915320",
            "telephone_number": "703-709-1114",
            "fax_number": "703-709-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 WIEHLE AVE",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "20190",
            "telephone_number": "703-709-1114",
            "fax_number": "703-709-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONETTI",
        "first_name": "BLAIR",
        "middle_name": "KATHERINE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-13",
        "last_updated": "2018-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110003695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLAIR",
            "last_name": "SNYDER",
            "middle_name": "KATHERINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Rhea Silva, LPC
• Silver Lining Assistance, Inc.
• Chiara Simeone-Difrancesco, PH.D.
• Angel A Simmons
• Stacey E. Simms, O.D.
• Dallas A Simons, PT, SCS, ATC
• Teresa C Simonson, PH.D.
• Suzanne K Simpkins, PHARMD
• Thomas Miller Simpson, PH.D.
• Sunanda Sindhwani, M.D.

• Physician Assistant in Reston, VA
• Providers in Reston, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.