Healthcare Provider Details

I. General information

NPI: 1396275426
Provider Name (Legal Business Name): SHEILA DIANE PERRY CPRS, CSAC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 WILLOMETT AVE
RICHMOND VA
23227-2921
US

IV. Provider business mailing address

604 WILLOMETT AVE
RICHMOND VA
23227-2921
US

V. Phone/Fax

Practice location:
  • Phone: 804-307-2914
  • Fax:
Mailing address:
  • Phone: 804-307-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1777
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: