Shady Grove Pediatrics, PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SHADY GROVE PEDIATRICS, PC

Practice address

11127 Journal Pkwy
King George, VA 22485-3468

Phone

(540) 775-6891

Fax

(540) 775-6894

NPI assigned

Nov 20, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ilya Zavelsky, MDNPI 1336386309

Title

Physician/Owner

Phone

(540) 775-6891

Specialties & licenses 1

Addresses

Other names 1

• King George Pediatrics Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ilya Zavelsky, M.D.

  • Pediatrics Physician
  • King George, VA
  • NPI 1336386309
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384905600000",
    "number": "1285064758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11127 JOURNAL PKWY",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224853468",
            "telephone_number": "540-775-6891",
            "fax_number": "540-775-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11127 JOURNAL PKWY",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224853468",
            "telephone_number": "540-775-6891",
            "fax_number": "540-775-6894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2013-11-20",
        "status": "A",
        "authorized_official_last_name": "ZAVELSKY",
        "authorized_official_first_name": "ILYA",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "540-775-6891",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King George Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassandra Annette Schein, LMT
• Hanna Schickel, PHARMD
• Emma Gabrielle Sellors
• Sentara Medical Group
• Sentara Medical Group
• Logan Anne Shearon, PA-C
• Winfield Scott Shirk, DDS
• Lillian Jade Simon
• Jennifer Gail Sindelar
• Hollie Elizabeth Sisemore

• Pediatrics Physician in King George, VA
• Providers in King George, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.