Healthcare Provider Details

I. General information

NPI: 1326532003
Provider Name (Legal Business Name): SHERYL D NEWCOMB NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 WILBORN AVE STE A
SOUTH BOSTON VA
24592-1662
US

IV. Provider business mailing address

2232 WILBORN AVE STE A
SOUTH BOSTON VA
24592-1662
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8977
  • Fax:
Mailing address:
  • Phone: 434-572-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: