Provider Demographics
NPI:1174531677
Name:VENKATESAN, SAILEELA (MD)
Entity type:Individual
Prefix:MRS
First Name:SAILEELA
Middle Name:
Last Name:VENKATESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-460-5521
Mailing Address - Fax:757-460-3817
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:STE 105
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-460-5521
Practice Address - Fax:757-460-3817
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101026024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006700624Medicaid
VA006700624Medicaid