Healthcare Provider Details

I. General information

NPI: 1760118558
Provider Name (Legal Business Name): NIDA ANJUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 08/03/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 SHERWOOD AVE
RICHMOND VA
23220-1210
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3137
  • Fax: 804-828-9493
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101285944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: