Healthcare Provider Details

I. General information

NPI: 1639991128
Provider Name (Legal Business Name): CHELSEA N SMYTH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 STONY POINT PARKWAY
RICHMOND VA
23235
US

IV. Provider business mailing address

1231 WINDSOR AVE
RICHMOND VA
23227-3744
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-8950
  • Fax: 804-560-7343
Mailing address:
  • Phone: 804-437-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1084510
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: