Healthcare Provider Details

I. General information

NPI: 1134899958
Provider Name (Legal Business Name): SHAWN OVIE UTSEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W FRANKLIN ST RM 302
RICHMOND VA
23284-9001
US

IV. Provider business mailing address

3511 KILBURN CIR STE 2031
HENRICO VA
23233-1159
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-4305
  • Fax:
Mailing address:
  • Phone: 917-974-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: