Healthcare Provider Details

I. General information

NPI: 1356288864
Provider Name (Legal Business Name): NATASHA RANDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 FRANKTOWN RD
HAMPTON VA
23663-1054
US

IV. Provider business mailing address

44 FRANKTOWN RD
HAMPTON VA
23663-1054
US

V. Phone/Fax

Practice location:
  • Phone: 757-272-1663
  • Fax: 757-273-6496
Mailing address:
  • Phone: 757-272-1663
  • Fax: 757-273-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: