Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0810003731 | VA |
Y | 103T00000X | Psychologist | 0810003731 | VA |
NPI | 1003082587 |
---|---|
Provider Name | Radha Sripathy Shankar |
First Address | Arlington, VA 22203-3728 |
Second Address | Arlington, VA 22203-3728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 19/06/2009 |