Provider Demographics
NPI:1609105188
Name:TANDON, MALA K (PSYD)
Entity type:Individual
Prefix:DR
First Name:MALA
Middle Name:K
Last Name:TANDON
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 HALL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1402
Mailing Address - Country:US
Mailing Address - Phone:571-332-9095
Mailing Address - Fax:703-644-6237
Practice Address - Street 1:11350 RANDOM HILLS RD STE 520
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7428
Practice Address - Country:US
Practice Address - Phone:571-332-9095
Practice Address - Fax:703-644-6237
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004632103TP2701X, 103TC2200X, 103TF0000X, 103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily