Healthcare Provider Details

I. General information

NPI: 1497107650
Provider Name (Legal Business Name): CASEY DASHIELL WILLAFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY LAUREN DASHIELL PA-C

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

IV. Provider business mailing address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

V. Phone/Fax

Practice location:
  • Phone: 757-282-4150
  • Fax:
Mailing address:
  • Phone: 757-282-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005422
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: