Healthcare Provider Details

I. General information

NPI: 1679736714
Provider Name (Legal Business Name): ANNA-CHRISTINA BEVELAQUA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 FAIRFAX AVE
NORFOLK VA
23507-2007
US

IV. Provider business mailing address

721 FAIRFAX AVE FL 3
NORFOLK VA
23507-2007
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-5915
  • Fax: 757-446-5969
Mailing address:
  • Phone: 757-446-7334
  • Fax: 757-446-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number265956
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101269322
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number265956
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101269322
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: