Healthcare Provider Details

I. General information

NPI: 1659207173
Provider Name (Legal Business Name): CYPRESS PATH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5906 HERMITAGE RD
HENRICO VA
23228-5564
US

IV. Provider business mailing address

5906 HERMITAGE RD
HENRICO VA
23228-5564
US

V. Phone/Fax

Practice location:
  • Phone: 804-316-7277
  • Fax: 276-258-6406
Mailing address:
  • Phone: 804-214-6912
  • Fax: 276-258-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHAUNA DANIELS
Title or Position: OWNER
Credential: LCSW
Phone: 804-316-7277