MEDICARE: ANGEL FLYNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86447946	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000000000	OTHER		NONE

General Provider Information

NPI Number	:	1619822640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL FLYNN

Provider Business Mailing Address
First Line	:	9401 COURTHOUSE RD STE 202
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6687
Country	:	US
Telephone Number	:	804-616-4378
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 COURTHOUSE RD STE 202
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6687
Country	:	US
Telephone Number	:	804-616-4378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ ANGEL FLYNN ” Practice Location

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