Healthcare Provider Details

I. General information

NPI: 1629985262
Provider Name (Legal Business Name): STARLING MEDICAL GROUP KS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MONTICELLO AVE STE 45790
NORFOLK VA
23510-2571
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1802
NORFOLK VA
23510-2670
US

V. Phone/Fax

Practice location:
  • Phone: 508-202-1011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY ROSKIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-202-1011