Healthcare Provider Details

I. General information

NPI: 1881898609
Provider Name (Legal Business Name): SUNDAR JOHN COOK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 1/2 N WASHINGTON ST
ALEXANDRIA VA
22314-2311
US

IV. Provider business mailing address

411 1/2 N WASHINGTON ST
ALEXANDRIA VA
22314-2311
US

V. Phone/Fax

Practice location:
  • Phone: 540-931-5238
  • Fax:
Mailing address:
  • Phone: 540-931-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810003809
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003809
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: