Provider Demographics
NPI:1235368184
Name:NANDYAL, DEEPA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:NANDYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:GOPALAKRISHNAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4508 YORKMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6157
Mailing Address - Country:US
Mailing Address - Phone:586-883-1559
Mailing Address - Fax:804-545-0607
Practice Address - Street 1:4508 YORKMINSTER DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6157
Practice Address - Country:US
Practice Address - Phone:586-883-1559
Practice Address - Fax:804-545-0607
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088586207R00000X
VA0101247385390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine