ELDEN ST. PEDIATRICS NPI 1215091038

NPI Information

  • NPI: 1215091038
  • Provider Name: ELDEN ST. PEDIATRICS
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 49D1096055
  • Address: 110 ELDEN ST
    SUITE #D
    HERNDON, VA
    ZIP 20170
  • Phone: (703) 471-6996

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NPI Details

ELDEN ST. PEDIATRICS is a pediatrics in Herndon, VA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. ELDEN ST. PEDIATRICS NPI is 1215091038. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

110 ELDEN ST
SUITE #D
HERNDON, VA
ZIP 20170-891
Phone: (703) 471-6996
Fax: (703) 435-7765

The provider's authorized official is Millicent M Tetteyfio .
The authorized official title is Rn.ofc.mgr and has the following contact phone number (703) 471-6996.

The CLIA number assigned to this NPI record is 49D1096055 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/20/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

What is NPI?

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This page was last updated on: 11/21/2025

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