Provider Demographics
NPI:1942487525
Name:SATHISH, MANJULA (MD)
Entity Type:Individual
Prefix:
First Name:MANJULA
Middle Name:
Last Name:SATHISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41740 DAISY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-1768
Mailing Address - Country:US
Mailing Address - Phone:601-519-3681
Mailing Address - Fax:601-968-0028
Practice Address - Street 1:1902 BRAEBURN DR STE 130
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-444-0460
Practice Address - Fax:540-444-0479
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS685L2084P0800X
MS219822084P0804X
VA01012573092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry