Provider Demographics
NPI:1659692036
Name:JONNALAGADDA, NAVEEN
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:
Last Name:JONNALAGADDA
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 1:13614 LEGACY CIR
Mailing Address - Street 2:APT E
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4708
Mailing Address - Country:US
Mailing Address - Phone:703-459-7657
Mailing Address - Fax:
Practice Address - Street 1:13614 LEGACY CIR
Practice Address - Street 2:APT E
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4708
Practice Address - Country:US
Practice Address - Phone:703-598-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000192246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant