Healthcare Provider Details

I. General information

NPI: 1174473433
Provider Name (Legal Business Name): FEDSERVE HAMPTON ROADS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HAMPTON BLVD STE 302
NORFOLK VA
23507-1503
US

IV. Provider business mailing address

4789 CHEROKEE ST
COLLEGE PARK MD
20740-1816
US

V. Phone/Fax

Practice location:
  • Phone: 301-841-5077
  • Fax:
Mailing address:
  • Phone: 301-841-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ODUKOYA
Title or Position: OWNER
Credential:
Phone: 301-841-5077