Provider Demographics
NPI:1811998016
Name:KADAKKAL, SREEJA (MD)
Entity type:Individual
Prefix:DR
First Name:SREEJA
Middle Name:
Last Name:KADAKKAL
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 1:3143 MAGIC HOLLOW BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3077
Mailing Address - Country:US
Mailing Address - Phone:757-385-0684
Mailing Address - Fax:757-493-5456
Practice Address - Street 1:289 INDEPENDENCE BLVD
Practice Address - Street 2:STE 312
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5493
Practice Address - Country:US
Practice Address - Phone:757-385-0684
Practice Address - Fax:757-493-5456
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist