MEDICARE: PRAJKTA INGLE SESSANGA O.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	0618002636	VA

General Provider Information

NPI Number	:	1184073264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAJKTA INGLE SESSANGA O.D., M.P.H.

Provider Business Mailing Address
First Line	:	1502 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1718
Country	:	US
Telephone Number	:	703-548-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1718
Country	:	US
Telephone Number	:	703-548-0122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	08/06/2019

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