Provider Demographics
NPI:1982439741
Name:DHANDAMUDY, SAMHITHA
Entity type:Individual
Prefix:
First Name:SAMHITHA
Middle Name:
Last Name:DHANDAMUDY
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 1:2473 ROLLING PLAINS DR APT SUITE
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3074
Mailing Address - Country:US
Mailing Address - Phone:703-945-6785
Mailing Address - Fax:
Practice Address - Street 1:1550 CRYSTAL DR STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-4108
Practice Address - Country:US
Practice Address - Phone:703-945-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202222282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist