Provider Demographics
NPI:1053821215
Name:SINGH, AMANDEEP (PA)
Entity Type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 BONDS RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1778
Mailing Address - Country:US
Mailing Address - Phone:301-659-0003
Mailing Address - Fax:
Practice Address - Street 1:6128 BRANDON AVE STE 208-210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2640
Practice Address - Country:US
Practice Address - Phone:301-659-0003
Practice Address - Fax:301-829-7694
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021402207R00000X
VA0110009129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine