Healthcare Provider Details

I. General information

NPI: 1457288060
Provider Name (Legal Business Name): DEEANA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 HULL ST APT 235
RICHMOND VA
23224-3959
US

IV. Provider business mailing address

1420 HULL ST APT 235
RICHMOND VA
23224-3959
US

V. Phone/Fax

Practice location:
  • Phone: 804-866-0868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberT4X8P8L8
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License NumberA7E3H6C4
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: