Provider Demographics
NPI:1114960846
Name:SHANDILYA, LOKNATH (MD)
Entity Type:Individual
Prefix:
First Name:LOKNATH
Middle Name:
Last Name:SHANDILYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 RIVERS BEND CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2554
Mailing Address - Country:US
Mailing Address - Phone:804-451-3650
Mailing Address - Fax:
Practice Address - Street 1:95 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9280
Practice Address - Country:US
Practice Address - Phone:804-450-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA453261OtherBC/BS PROVIDER #
VA005862884Medicaid
VAG17541Medicare UPIN
VA453261OtherBC/BS PROVIDER #