Provider Demographics
NPI:1245918655
Name:SARAVANANE, PERRAYCHUDHAN
Entity type:Individual
Prefix:
First Name:PERRAYCHUDHAN
Middle Name:
Last Name:SARAVANANE
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 1:7089 MECHANICSVILLE TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3609
Mailing Address - Country:US
Mailing Address - Phone:804-417-7788
Mailing Address - Fax:
Practice Address - Street 1:7089 MECHANICSVILLE TPKE STE A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3609
Practice Address - Country:US
Practice Address - Phone:804-417-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419562122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program