Provider Demographics
NPI:1841683836
Name:TANDON, NIDHI JAIN (CCC)
Entity type:Individual
Prefix:MRS
First Name:NIDHI
Middle Name:JAIN
Last Name:TANDON
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23102 BRONSTEIN LN
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-5698
Mailing Address - Country:US
Mailing Address - Phone:703-297-7842
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 520
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7428
Practice Address - Country:US
Practice Address - Phone:703-951-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000759235Z00000X
VA2202007516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist