Provider Demographics
NPI:1457641888
Name:REGUNATHAN-SHENK, RENU (MD)
Entity type:Individual
Prefix:DR
First Name:RENU
Middle Name:
Last Name:REGUNATHAN-SHENK
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 1:3930 WALNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4750
Mailing Address - Country:US
Mailing Address - Phone:703-246-9246
Mailing Address - Fax:703-246-9257
Practice Address - Street 1:3930 WALNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4750
Practice Address - Country:US
Practice Address - Phone:703-246-9246
Practice Address - Fax:703-246-9257
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263061207RN0300X
NY273806207RN0300X
DCMD045592207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101263061OtherMEDICAL LICENSE