Provider Demographics
NPI:1679979876
Name:MUNDRU, SILPA
Entity type:Individual
Prefix:
First Name:SILPA
Middle Name:
Last Name:MUNDRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13053 STARLING CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3739
Mailing Address - Country:US
Mailing Address - Phone:571-230-2782
Mailing Address - Fax:800-985-9749
Practice Address - Street 1:13053 STARLING CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3739
Practice Address - Country:US
Practice Address - Phone:571-230-2782
Practice Address - Fax:800-985-9749
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204956208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation