Saly Damigou Moukdagou, REGISTERED NURSE

Primary specialty

Child & Adolescent Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0807X

License

0001279380 Issued in VA

Practice address

12255 Fair Lakes Pkwy
Fairfax, VA 22033-3952

Phone

(703) 934-5700

NPI assigned

Jun 8, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1962027755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10821 CLOVER CT",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201097246",
            "telephone_number": "571-267-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 FAIR LAKES PKWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333952",
            "telephone_number": "703-934-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUKDAGOU",
        "first_name": "SALY",
        "middle_name": "DAMIGOU",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "VA",
            "license": "0001279380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Fairfax",
            "affiliation": "N",
            "endpointDescription": "Work Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Work",
            "address_1": "12255 Fair Lakes Pkwy",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220333952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Farha B Motiwala, M.D.
• Ronald W Motley, PHD
• Michelle Motsch, FNP-BC
• William Mott, DPT
• Mouhamad Jamil MD Pulmonary Sleep Medicine PLLC
• Alison Dara Moulton, CCC-SLP
• Camille Lewis Mountjoy
• Mary Moussa, LPC, CSAC
• Kristin L. Russell Mouttet, M.S. , LMFT
• Elizabeth Smith Moynahan, PHARM D

• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; 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.