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ELDEN ST. PEDIATRICS
NPI 1215091038
Pediatrics in Herndon, VA

Active since December 20, 2006CLIA 49D1096055 · Waiver
110 ELDEN ST, SUITE #D, HERNDON, VA 20170(703) 471-6996(703) 435-7765 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Elden St. Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELDEN ST. PEDIATRICS (NPI 1215091038) is a healthcare organization registered as a pediatrics in Herndon, Virginia and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through February 23, 2027 and lists Millicent M Tetteyfio, Rn.ofc.mgr, as its authorized official.

NPPES Registry Identity

NPI1215091038
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameELDEN ST. PEDIATRICS
Location Address110 ELDEN ST, SUITE #DHerndon, VA 20170-4891
Mailing Address110 Elden St, Suite #dHerndon, VA 20170-4891 · (703) 471-6996 · Fax (703) 435-7765
Phone(703) 471-6996
Fax(703) 435-7765
Organization SubpartNo
Authorized OfficialMillicent M TetteyfioRn.ofc.mgr · (703) 471-6996
Enumeration DateDecember 20, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1215091038 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition

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.

110 ELDEN ST, Herndon, VA 20170
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1096055

Elden St Pediatrics · Herndon, VA
Active · expires Feb 23, 2027
CLIA Number49D1096055
Laboratory TypePhysician Office
Certificate Effective DateFebruary 24, 2025
Certificate Expiration DateFebruary 23, 2027
Laboratory DirectorSithu Win
Laboratory Phone(703) 471-6996
Laboratory LocationElden St Pediatrics110 Elden Street - Suite D, Herndon, VA 20170
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. SALAH M NEBERAI MD
Pediatrics (Hospice and Palliative Medicine)
110 ELDEN ST, D
HERNDON, VA 20170
Fairfax County (703) 471-6996
SITHU WIN MD
Pediatrics
110 ELDEN ST, SUITE D
HERNDON, VA 20170
Fairfax County (703) 471-6996

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Elden St. Pediatrics's NPI number?

The NPI number for Elden St. Pediatrics is 1215091038. It was assigned to this organization in the NPPES registry on December 20, 2006.

Where is Elden St. Pediatrics located?

Elden St. Pediatrics is located at 110 Elden St Suite #d, Herndon, VA 20170. The listed phone number is (703) 471-6996.

What is Elden St. Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Elden St. Pediatrics hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D1096055) is associated with this NPI, valid through February 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Elden St. Pediatrics was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.