Formoly, Mohammad Shahim

Formoly, Mohammad Shahim is an sole proprietor health care provider with primary practice located at 12011 Lee Jackson Memorial Hwy Ste 501 , Fairfax VA 22033. He recently has only one registered license in Technologists, Technicians & Other Technical Service Providers / Surgical Assistant, which is considered as his primary health care specialty. Formoly, Mohammad Shahim can be contacted via phone (703) 349-1379.

Contact Information

Primary practice address
12011 Lee Jackson Memorial Hwy Ste 501 Fairfax VA 22033
Phone: (703) 349-1379
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Surgical Assistant 246ZC0007X 4160

Profile Details

NPI number 1992104954
LBN Legal business name Formoly, Mohammad Shahim
Credentials CSA
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 15th, 2014
Last updated Sep 6th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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