Healthcare Provider Details

I. General information

NPI: 1619157195
Provider Name (Legal Business Name): CHANNA STEFANEE COLLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANNA S BAILEY PA-C

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6005
  • Fax: 757-388-6006
Mailing address:
  • Phone: 757-388-6005
  • Fax: 757-388-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: