Healthcare Provider Details

I. General information

NPI: 1073173696
Provider Name (Legal Business Name): TATIANNA CANADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 ONANCOCK TRL
NEWPORT NEWS VA
23602-4367
US

IV. Provider business mailing address

1706 TODDS LN # 301
HAMPTON VA
23666-3123
US

V. Phone/Fax

Practice location:
  • Phone: 810-288-0221
  • Fax:
Mailing address:
  • Phone: 810-597-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: