Healthcare Provider Details

I. General information

NPI: 1538859772
Provider Name (Legal Business Name): SHERRI KUNTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE STE 310
NORFOLK VA
23507-1914
US

IV. Provider business mailing address

500 J CLYDE MORRIS BLVD # 300
NEWPORT NEWS VA
23601-1929
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-7979
  • Fax:
Mailing address:
  • Phone: 757-612-7300
  • Fax: 757-933-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0024187076
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: