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General NPI Number Information
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NPI Number | 1497069702
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Entity Type | Individual
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Provider Name | SHRUTHI MANJUNATHA CHANDRASHEKHAR VIJAYALAKSHMI MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 4191 INNSLAKE DR STE 211
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3324
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Country | US
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Telephone | 804-828-3144
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Fax | 804-628-7104
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Provider Business Mailing Address
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Address Line | 4191 INNSLAKE DR STE 211
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3324
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Country | US
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Telephone | 804-358-6100
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Fax | 804-342-7619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101250225
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License Number State | VA
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