Healthcare Provider Details

I. General information

NPI: 1063221208
Provider Name (Legal Business Name): MALAVIKA SANTHOSH NAIR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY STE 310
RESTON VA
20190-3300
US

IV. Provider business mailing address

12070 OLD LINE CTR STE 212
WALDORF MD
20602-2567
US

V. Phone/Fax

Practice location:
  • Phone: 703-570-5227
  • Fax:
Mailing address:
  • Phone: 301-710-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: