Provider Demographics
NPI:1871974121
Name:KANAGANAYAGAM, SHEVANTHI U (PLMHP)
Entity type:Individual
Prefix:
First Name:SHEVANTHI
Middle Name:U
Last Name:KANAGANAYAGAM
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5867 TULLOCH SPRING CT
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6159
Mailing Address - Country:US
Mailing Address - Phone:402-671-1716
Mailing Address - Fax:
Practice Address - Street 1:5867 TULLOCH SPRING CT
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6159
Practice Address - Country:US
Practice Address - Phone:571-293-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health