Healthcare Provider Details

I. General information

NPI: 1356206452
Provider Name (Legal Business Name): ANITA MALASANI PRASAD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9335 CHAMBERLAYNE RD
MECHANICSVILLE VA
23116-2805
US

IV. Provider business mailing address

387 BAKERS FERRY TRL
MARTINEZ GA
30907-4902
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-2956
  • Fax: 804-264-0447
Mailing address:
  • Phone: 706-231-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003594
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: