Healthcare Provider Details

I. General information

NPI: 1447070545
Provider Name (Legal Business Name): JOHANNA BYRD SUTTENFIELD BCABA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 MARKEL RD
RICHMOND VA
23230-3008
US

IV. Provider business mailing address

5311 MARKEL RD
RICHMOND VA
23230-3008
US

V. Phone/Fax

Practice location:
  • Phone: 804-612-1947
  • Fax: 804-612-1955
Mailing address:
  • Phone: 804-612-1947
  • Fax: 804-612-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000581
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: