Provider Demographics
NPI:1710646492
Name:SURESH, MISHALINI (PA-C)
Entity Type:Individual
Prefix:
First Name:MISHALINI
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MISHA
Other - Middle Name:
Other - Last Name:SURESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9266 HILLIS CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5823
Mailing Address - Country:US
Mailing Address - Phone:703-328-4094
Mailing Address - Fax:
Practice Address - Street 1:2006 HEALTH CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:406-895-5555
Practice Address - Fax:757-579-8607
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant