Healthcare Provider Details

I. General information

NPI: 1003919622
Provider Name (Legal Business Name): NELLIE M SANKARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W WASHINGTON ST
SUFFOLK VA
23439
US

IV. Provider business mailing address

PO BOX 1815 440 W WASHINGTON ST
SUFFOLK VA
23439-1815
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-4822
  • Fax: 757-925-0346
Mailing address:
  • Phone: 757-539-4822
  • Fax: 757-925-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101027177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: