Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 0101250220 | VA |
NPI | 1407017064 |
---|---|
Provider Name | Dr. Amy Shah Boutsikaris |
First Address | Falls Church, VA 22042-3307 |
Second Address | Falls Church, VA 22042-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 29/04/2013 |