Healthcare Provider Details

I. General information

NPI: 1114526290
Provider Name (Legal Business Name): DIANA VECERDEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 BATTLEFIELD BLVD S
CHESAPEAKE VA
23322-5311
US

IV. Provider business mailing address

1604 RIVER ROCK REACH
CHESAPEAKE VA
23321-6612
US

V. Phone/Fax

Practice location:
  • Phone: 757-482-4368
  • Fax: 757-482-2415
Mailing address:
  • Phone: 757-620-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202214137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: