Healthcare Provider Details

I. General information

NPI: 1457265001
Provider Name (Legal Business Name): SERENITY INFUSION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BRIGGS RD STE 201
CHESTER VA
23831-5335
US

IV. Provider business mailing address

12901 BRIGGS RD STE 201
CHESTER VA
23831-5335
US

V. Phone/Fax

Practice location:
  • Phone: 804-604-1233
  • Fax:
Mailing address:
  • Phone: 804-604-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MUMTHAS BEEGOM PALLATH
Title or Position: MANAGING DIRECTOR
Credential: MSNA CRNA DNAP
Phone: 804-604-1233