Basic Information
| Provider Information | |||||||||
| NPI: | 1902132848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNEETHA SHASHIDHAR, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 CHAIN BRIDGE RD APT T2 | ||||||||
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| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221815553 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220423307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037764001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2009 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | ANNAVARAPU | ||||||||
| AuthorizedOfficialFirstName: | SUNEETHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7033493796 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 0101246318 | VA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1639328438 | 01 | NPI | OTHER |