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KING GEORGE PEDIATRICS
NPI 1285064758
Pediatrics in King George, VA

Active since November 20, 2013CLIA 49D2071069 · Waiver
11127 JOURNAL PKWY, KING GEORGE, VA 22485(540) 775-6891(540) 775-6894 Get Directions Write a Review

NPPES record last updated: November 20, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About King George Pediatrics NPPES

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

KING GEORGE PEDIATRICS (NPI 1285064758) is a healthcare organization registered as a pediatrics in King George, Virginia and active in the NPI registry since November 2013. The organization holds a CLIA Waiver certificate valid through January 1, 2028 and lists Ilya Zavelsky, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1285064758
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSHADY GROVE PEDIATRICS, PC
Location Address11127 JOURNAL PKWYKing George, VA 22485-3468
Mailing Address11127 Journal PkwyKing George, VA 22485-3468 · (540) 775-6891 · Fax (540) 775-6894
Phone(540) 775-6891
Fax(540) 775-6894
Organization SubpartNo
Authorized OfficialIlya ZavelskyPhysician/owner · (540) 775-6891
Enumeration DateNovember 20, 2013
✔ NPI 1285064758 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.
11127 JOURNAL PKWY, King George, VA 22485
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Other Names 1

Doing Business AsKing George Pediatrics

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 49D2071069

King George Pediatrics · King George, VA
Active · expires Jan 1, 2028
CLIA Number49D2071069
Laboratory TypePhysician Office
Certificate Effective DateJanuary 2, 2026
Certificate Expiration DateJanuary 1, 2028
Laboratory DirectorIlya Zavelsky
Laboratory Phone(540) 775-6891
Laboratory LocationKing George Pediatrics11127 Journal Parkway, King George, VA 22485
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

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

DR. ILYA ZAVELSKY M.D.
Pediatrics
11127 JOURNAL PKWY, STE 101
KING GEORGE, VA 22485
King George County (540) 775-6891

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 Shady Grove Pediatrics, PC's NPI number?

The NPI number for Shady Grove Pediatrics, PC is 1285064758. It was assigned to this organization in the NPPES registry on November 20, 2013. The provider is doing business as King George Pediatrics.

Where is Shady Grove Pediatrics, PC located?

Shady Grove Pediatrics, PC is located at 11127 Journal Pkwy, King George, VA 22485. The listed phone number is (540) 775-6891.

What is Shady Grove Pediatrics, PC's specialty?

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

Does Shady Grove Pediatrics, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2071069) is associated with this NPI, valid through January 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shady Grove Pediatrics, PC was last updated on November 20, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.