Provider Demographics
NPI:1063464113
Name:UCHELLA, SUNDAY C (MD)
Entity type:Individual
Prefix:DR
First Name:SUNDAY
Middle Name:C
Last Name:UCHELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 CREEK CREST WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4608
Mailing Address - Country:US
Mailing Address - Phone:703-499-8999
Mailing Address - Fax:703-499-8996
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY.
Practice Address - Street 2:#402
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3311
Practice Address - Country:US
Practice Address - Phone:703-499-8999
Practice Address - Fax:703-499-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052828207P00000X, 208000000X
MDD47415208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010208351Medicaid
VA004029E76Medicare ID - Type Unspecified