Provider Demographics
NPI:1851894729
Name:RONDOT, SHANTHI (AGPNP)
Entity type:Individual
Prefix:
First Name:SHANTHI
Middle Name:
Last Name:RONDOT
Suffix:
Gender:F
Credentials:AGPNP
Other - Prefix:
Other - First Name:SHANTHI
Other - Middle Name:
Other - Last Name:PERERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 CHALMERS CT
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1347
Practice Address - Country:US
Practice Address - Phone:540-955-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175303363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology