Healthcare Provider Details

I. General information

NPI: 1144986985
Provider Name (Legal Business Name): ANNETTE MARIE CUDNOHUFSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE MARIE BATISTA-NEGRON

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E LITTLE CREEK RD STE 204
NORFOLK VA
23518-4137
US

IV. Provider business mailing address

8115 DIVEN ST
NORFOLK VA
23505-1417
US

V. Phone/Fax

Practice location:
  • Phone: 804-261-4163
  • Fax:
Mailing address:
  • Phone: 805-433-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-193062
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: