Healthcare Provider Details

I. General information

NPI: 1154256675
Provider Name (Legal Business Name): MELISSA DIANE BERRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 WESTOVER HILLS BLVD APT E
RICHMOND VA
23225-4538
US

IV. Provider business mailing address

617 WESTOVER HILLS BLVD APT E
RICHMOND VA
23225-4538
US

V. Phone/Fax

Practice location:
  • Phone: 804-629-3558
  • Fax:
Mailing address:
  • Phone: 804-629-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberNPCN-17565-15013
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberNPCN-17565-15013
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: