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NPI Code Detail

MEDICARE: DR. SHRUTHI MANJUNATHA CHANDRASHEKHAR VIJAYALAKSHMI MD

MEDICARE: DR. SHRUTHI MANJUNATHA CHANDRASHEKHAR VIJAYALAKSHMI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician0101250225VA

General Provider Information

NPI Number : 1497069702
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHRUTHI MANJUNATHA CHANDRASHEKHAR VIJAYALAKSHMI MD
Provider Business Mailing Address
First Line : 4191 INNSLAKE DR STE 211
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-3324
Country : US
Telephone Number : 804-358-6100
Fax Number : 804-342-7619
Provider Business Practice Location Address
First Line : 4191 INNSLAKE DR STE 211
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-3324
Country : US
Telephone Number : 804-828-3144
Fax Number : 804-628-7104
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2010
Last Update Date : 10/01/2024

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