Provider Demographics
NPI:1104381318
Name:DIN, SUNDAS
Entity type:Individual
Prefix:
First Name:SUNDAS
Middle Name:
Last Name:DIN
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 1:25658 CABIN POINT CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5700
Mailing Address - Country:US
Mailing Address - Phone:248-729-3008
Mailing Address - Fax:
Practice Address - Street 1:7501 HERITAGE VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3078
Practice Address - Country:US
Practice Address - Phone:571-248-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist