Provider Demographics
NPI:1154740140
Name:PANNEERCHELVAM, NITHIYAKALYANI
Entity type:Individual
Prefix:DR
First Name:NITHIYAKALYANI
Middle Name:
Last Name:PANNEERCHELVAM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:NITHIYAKALYANI
Other - Middle Name:
Other - Last Name:PANNEERCHELVAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-391-0900
Mailing Address - Fax:
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-391-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics