Healthcare Provider Details

I. General information

NPI: 1639007792
Provider Name (Legal Business Name): HEALTHYCONNECT OF VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WESTERRE PKWY
RICHMOND VA
23233-1478
US

IV. Provider business mailing address

4030 HENDERSON BLVD STE 598
TAMPA FL
33629-4940
US

V. Phone/Fax

Practice location:
  • Phone: 813-334-7442
  • Fax:
Mailing address:
  • Phone: 813-334-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK ANTHONY BURRIS
Title or Position: MANAGER/CFO
Credential:
Phone: 813-334-7442