Provider Demographics
NPI:1497121982
Name:TATE, SUNDI ELAINA (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:SUNDI
Middle Name:ELAINA
Last Name:TATE
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 TELESTAR CT STE 300
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:2901 TELESTAR CT # 600
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1260
Practice Address - Country:US
Practice Address - Phone:703-621-4503
Practice Address - Fax:703-766-5921
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172770363LA2200X, 363LG0600X
DCRN1039330363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497121982Medicaid
VA30016759620001Medicaid
MD30016759620002Medicaid