Healthcare Provider Details

I. General information

NPI: 1821564154
Provider Name (Legal Business Name): TAJA MASHAY ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAJA M DYE RN, BSN

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 KEMPSVILLE CIR STE 315
NORFOLK VA
23502-3935
US

IV. Provider business mailing address

224 CASTLEBERRY DR
CHESAPEAKE VA
23322-3530
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-5400
  • Fax: 757-461-3305
Mailing address:
  • Phone: 423-834-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024176751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: