Healthcare Provider Details

I. General information

NPI: 1700106424
Provider Name (Legal Business Name): S. CARRINGTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14904 JEFFERSON DAVIS HWY STE 105
WOODBRIDGE VA
22191-3908
US

IV. Provider business mailing address

14904 JEFFERSON DAVIS HWY STE 105
WOODBRIDGE VA
22191-3908
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8171
  • Fax: 703-490-8172
Mailing address:
  • Phone: 703-490-8171
  • Fax: 703-490-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301025
License Number StateVA

VIII. Authorized Official

Name: DR. SHAUNN D MALAKA
Title or Position: OWNER
Credential: DPM
Phone: 703-232-5776