Provider Demographics
NPI:1104645217
Name:CHILLARA, SAKETH VENKATA
Entity type:Individual
Prefix:
First Name:SAKETH
Middle Name:VENKATA
Last Name:CHILLARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 DAYS FARM DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-7302
Mailing Address - Country:US
Mailing Address - Phone:571-205-3789
Mailing Address - Fax:
Practice Address - Street 1:1964 GALLOWS RD STE UNIT280
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3814
Practice Address - Country:US
Practice Address - Phone:571-533-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician