Provider Demographics
NPI:1407948953
Name:CANADY, SITA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SITA
Middle Name:S
Last Name:CANADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SITA
Other - Middle Name:M
Other - Last Name:SUNDARESAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1123 HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4828
Mailing Address - Country:US
Mailing Address - Phone:540-899-2555
Mailing Address - Fax:540-899-3554
Practice Address - Street 1:1123 HEATHERSTONE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4828
Practice Address - Country:US
Practice Address - Phone:540-899-5555
Practice Address - Fax:540-899-3554
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234606208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010094844Medicaid
I17318Medicare UPIN
VAI17318Medicare UPIN
VA009343U92Medicare ID - Type Unspecified