Provider Demographics
NPI:1104586551
Name:VIJAYA, FNU SHILPA
Entity type:Individual
Prefix:
First Name:FNU SHILPA
Middle Name:
Last Name:VIJAYA
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 1:6032 COLLINSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7104
Mailing Address - Country:US
Mailing Address - Phone:512-947-4210
Mailing Address - Fax:
Practice Address - Street 1:3904 HULL STREET RD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1714
Practice Address - Country:US
Practice Address - Phone:804-233-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist