Individual ProviderCarillon S VeltsistasNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 391-3129(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Carillon S Veltsistas does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1740374602Provider TypeIndividualFull NameVeltsistas, Carillon STitleMs.CredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date10/3/2006Last Updated3/30/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 391-3129Fax(703) 391-3006Mailing LocationMailing Address3998 Fair Ridge Dr, Suite 300, Fairfax, VA 22033-2907Phone(703) 295-9360Fax(703) 766-9725Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024124925VirginiaProvider IdentifiersIDDescriptionIssuerID484645DescriptionOtherIssuerNCPPOVirginiaIDK142-0002DescriptionOtherIssuerCARE FIRST 2005VirginiaID139230DescriptionOtherIssuerTRIGONVirginiaID1740374602DescriptionMedicaidIssuerUnlistedVirginia