Healthcare Provider Details

I. General information

NPI: 1629567565
Provider Name (Legal Business Name): SHER SINGH TUCKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 2ND STREET
RICHMOND VA
23219
US

IV. Provider business mailing address

PO BOX 980308
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9452
  • Fax:
Mailing address:
  • Phone: 804-827-0053
  • Fax: 804-828-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102206158
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: