Healthcare Provider Details

I. General information

NPI: 1326279084
Provider Name (Legal Business Name): KOSTADINKA HADZIJSKA SKANDEVA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 FULLER CT
ALEXANDRIA VA
22310-2541
US

IV. Provider business mailing address

6151 FULLER CT
ALEXANDRIA VA
22310-2541
US

V. Phone/Fax

Practice location:
  • Phone: 571-480-8480
  • Fax: 703-888-3909
Mailing address:
  • Phone: 571-480-8480
  • Fax: 703-888-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103301045
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: