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General NPI Number Information
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NPI Number | 1497121982
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Entity Type | Individual
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Provider Name | SUNDI ELAINA TATE AGNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 2901 TELESTAR CT # 600
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1260
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Country | US
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Telephone | 703-621-4503
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Fax | 703-766-5921
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Provider Business Mailing Address
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Address Line | 2901 TELESTAR CT STE 300
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1263
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Country | US
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Telephone | 703-591-1688
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Fax | 703-591-1445
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024172770
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License Number State | VA
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