Provider Demographics
NPI:1730714999
Name:KILDAY, SUSAN (MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KILDAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10274 GREENSPIRE DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2662
Mailing Address - Country:US
Mailing Address - Phone:703-380-0731
Mailing Address - Fax:
Practice Address - Street 1:10274 GREENSPIRE DR
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2662
Practice Address - Country:US
Practice Address - Phone:703-380-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA48870387225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty