Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shabnam Shukrullah, PHYSICIANASSISTANT

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1346081718

Shabnam Shukrullah, PHYSICIANASSISTANT is a Physician Assistant in Reston, Virginia. Qualified in 2024, 2 years ago. Practices with Potomac Urology Center, LLC, a 17-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
2
Licensed in
VA
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

1800 Jonathan Way
Reston, VA 20190-3592
Phone: (571) 888-9339
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (VA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1346081718
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedJune 1, 2024
Last updated in NPPESJune 1, 2024
Certification dateMarch 15, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Potomac Urology Center, Llc — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Reston