Healthcare Provider Details

I. General information

NPI: 1659937480
Provider Name (Legal Business Name): MS. MILINYA M MAXEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7278 HANOVER GREEN DR
MECHANICSVILLE VA
23111-1714
US

IV. Provider business mailing address

7278 HANOVER GREEN DR
MECHANICSVILLE VA
23111-1714
US

V. Phone/Fax

Practice location:
  • Phone: 804-727-4045
  • Fax:
Mailing address:
  • Phone: 804-727-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019009933
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: