Healthcare Provider Details

I. General information

NPI: 1083100770
Provider Name (Legal Business Name): AYZIA BUMBREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 INDEPENDENCE PKWY
CHESAPEAKE VA
23320-5206
US

IV. Provider business mailing address

714 FIRETHORN RD
CHESAPEAKE VA
23320-3507
US

V. Phone/Fax

Practice location:
  • Phone: 757-716-7067
  • Fax:
Mailing address:
  • Phone: 540-455-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: