Healthcare Provider Details

I. General information

NPI: 1821808742
Provider Name (Legal Business Name): MADISON SEHESTEDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE
NORFOLK VA
23507-1912
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-5600
  • Fax:
Mailing address:
  • Phone: 804-922-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011129
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: