Provider Demographics
NPI:1083366884
Name:NALLAPERUMA, SHANTHA K
Entity Type:Individual
Prefix:
First Name:SHANTHA
Middle Name:K
Last Name:NALLAPERUMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 CROSSRAIL CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1810
Mailing Address - Country:US
Mailing Address - Phone:571-471-8800
Mailing Address - Fax:
Practice Address - Street 1:5534 CROSSRAIL CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1810
Practice Address - Country:US
Practice Address - Phone:571-471-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program