Provider Demographics
NPI:1326279084
Name:SKANDEVA, KOSTADINKA HADZIJSKA (DPM)
Entity Type:Individual
Prefix:
First Name:KOSTADINKA
Middle Name:HADZIJSKA
Last Name:SKANDEVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2541
Mailing Address - Country:US
Mailing Address - Phone:571-480-8480
Mailing Address - Fax:703-888-3909
Practice Address - Street 1:6151 FULLER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2541
Practice Address - Country:US
Practice Address - Phone:571-480-8480
Practice Address - Fax:703-888-3909
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301045213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326279084Medicaid
239012Medicare UPIN