Healthcare Provider Details

I. General information

NPI: 1114226313
Provider Name (Legal Business Name): AMANDA JOAN BAILEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE STE 206
RICHMOND VA
23229-4946
US

IV. Provider business mailing address

7611 FOREST AVE STE 206
RICHMOND VA
23229-4946
US

V. Phone/Fax

Practice location:
  • Phone: 804-968-4435
  • Fax:
Mailing address:
  • Phone: 804-968-4435
  • Fax: 804-968-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0102206125
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: