Basic Information
| Provider Information | |||||||||
| NPI: | 1679958714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORRELL | ||||||||
| FirstName: | SHUCHITA | ||||||||
| MiddleName: | VANDRA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSN, CRNP, FNP-C | ||||||||
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| OtherLastName: | VANDRA | ||||||||
| OtherFirstName: | SHUCHITA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 EMBARCADERO CTR STE 1900 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941113723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156586791 | ||||||||
| FaxNumber: | 4155200904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1775 TYSONS BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | TYSONS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221024285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026271904 | ||||||||
| FaxNumber: | 2026600025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024177546 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.