Provider Demographics
NPI:1508074543
Name:PRADHAN, SHILPI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPI
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 STILLMAN PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4197
Mailing Address - Country:US
Mailing Address - Phone:804-270-3333
Mailing Address - Fax:804-270-9333
Practice Address - Street 1:3960 STILLMAN PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4197
Practice Address - Country:US
Practice Address - Phone:804-270-3333
Practice Address - Fax:804-270-9333
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252063207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV8581E321OtherMEDICARE PTAN
VA2015127842Medicaid