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General NPI Number Information
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NPI Number | 1922992510
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Entity Type | Individual
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Provider Name | FANCY CHRISTINA KUMARARAJA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 14346 WARWICK BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-3814
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Country | US
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Telephone | 754-755-8771
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Fax |
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Provider Business Mailing Address
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Address Line | 115 BEACH 62ND ST UNIT B
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City | ARVERNE
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State | NY
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Zip | 11692-1884
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Country | US
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Telephone | 718-374-1224
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401419614
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License Number State | VA
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