Healthcare Provider Details

I. General information

NPI: 1427925320
Provider Name (Legal Business Name): REGINA JANELLE SLAUGHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/24/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 HIGH ST W
PORTSMOUTH VA
23703-4504
US

IV. Provider business mailing address

5800 HIGH ST W
PORTSMOUTH VA
23703-4504
US

V. Phone/Fax

Practice location:
  • Phone: 757-686-3716
  • Fax:
Mailing address:
  • Phone: 757-686-3716
  • Fax: 757-686-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020121
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: