Healthcare Provider Details

I. General information

NPI: 1841683836
Provider Name (Legal Business Name): NIDHI JAIN TANDON CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 MERCURE CIR STE 252
STERLING VA
20166-3801
US

IV. Provider business mailing address

23102 BRONSTEIN LN
BRAMBLETON VA
20148-5698
US

V. Phone/Fax

Practice location:
  • Phone: 703-951-3068
  • Fax:
Mailing address:
  • Phone: 703-297-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202007516
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP000759
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: