Healthcare Provider Details

I. General information

NPI: 1700697901
Provider Name (Legal Business Name): JAENA SHEI TAITAGUE SCHOLTEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 CITY CENTER BLVD STE 200
NEWPORT NEWS VA
23606-3080
US

IV. Provider business mailing address

18 S GREENFIELD AVE
HAMPTON VA
23666-2628
US

V. Phone/Fax

Practice location:
  • Phone: 757-599-4090
  • Fax:
Mailing address:
  • Phone: 804-854-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: