Healthcare Provider Details

I. General information

NPI: 1154292548
Provider Name (Legal Business Name): MS. SHERANDA BURWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA WILES

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 15TH ST
RICHMOND VA
23224-3858
US

IV. Provider business mailing address

301 N NINTH ST
RICHMOND VA
23219-1933
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-5078
  • Fax:
Mailing address:
  • Phone: 804-780-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPROV-0666658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: