Healthcare Provider Details

I. General information

NPI: 1568323277
Provider Name (Legal Business Name): SANDHYA POUDEL SUBEDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

IV. Provider business mailing address

101 CABARRUS AVE E STE 200
CONCORD NC
28025-3781
US

V. Phone/Fax

Practice location:
  • Phone: 800-765-7130
  • Fax: 800-765-7130
Mailing address:
  • Phone: 855-743-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024194533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: