Healthcare Provider Details

I. General information

NPI: 1730922931
Provider Name (Legal Business Name): JACQUELYN ELIZABETH MAYS SURGICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

11399 OAKRISE RD
NEW KENT VA
23124-2132
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8203
  • Fax:
Mailing address:
  • Phone: 804-647-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: