Healthcare Provider Details

I. General information

NPI: 1528753209
Provider Name (Legal Business Name): SIERRA FAYE MAGGARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF PEDIATRICS RESIDENCY 1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

GME ADMIN, 1200 EAST BROAD STREET, BOX 980257
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-0534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102210185
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: