Healthcare Provider Details

I. General information

NPI: 1548067044
Provider Name (Legal Business Name): SARAH TAVENNER WHITAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

417 N 11TH ST
RICHMOND VA
23298-5024
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-1204
  • Fax: 804-828-1572
Mailing address:
  • Phone: 804-827-1204
  • Fax: 804-828-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0116042351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: