Healthcare Provider Details

I. General information

NPI: 1225805054
Provider Name (Legal Business Name): AMY MUSIC CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 KEMPSVILLE RD
NORFOLK VA
23502-2634
US

IV. Provider business mailing address

1135 KEMPSVILLE RD
NORFOLK VA
23502-2634
US

V. Phone/Fax

Practice location:
  • Phone: 757-717-2802
  • Fax:
Mailing address:
  • Phone: 757-717-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: