Healthcare Provider Details

I. General information

NPI: 1407948953
Provider Name (Legal Business Name): SITA S. CANADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SITA M. SUNDARESAN M.D.

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 FAIR RIDGE DR
FAIRFAX VA
22033-2917
US

IV. Provider business mailing address

4001 FAIR RIDGE DR STE 305
FAIRFAX VA
22033-2917
US

V. Phone/Fax

Practice location:
  • Phone: 540-701-4767
  • Fax:
Mailing address:
  • Phone: 540-701-4767
  • Fax: 703-520-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: