Provider Demographics
NPI:1003919622
Name:SANKARAN, NELLIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:NELLIE
Middle Name:M
Last Name:SANKARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1815
Mailing Address - Street 2:440 W WASHINGTON ST
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-1815
Mailing Address - Country:US
Mailing Address - Phone:757-539-4822
Mailing Address - Fax:757-925-0346
Practice Address - Street 1:440 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23439
Practice Address - Country:US
Practice Address - Phone:757-539-4822
Practice Address - Fax:757-925-0346
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101027177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07737Medicare UPIN