Healthcare Provider Details

I. General information

NPI: 1770340150
Provider Name (Legal Business Name): SEAMUS MCKELVEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HELICOPTER RD BLDG 3812
VIRGINIA BEACH VA
23459-8913
US

IV. Provider business mailing address

5444 BROCKIE ST
VIRGINIA BEACH VA
23464-7737
US

V. Phone/Fax

Practice location:
  • Phone: 215-410-6490
  • Fax:
Mailing address:
  • Phone: 215-410-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005453
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: