Healthcare Provider Details

I. General information

NPI: 1710881883
Provider Name (Legal Business Name): DAWN MARIE SODERHOLM RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 205
SUFFOLK VA
23434-8154
US

IV. Provider business mailing address

246 WOODLAND DR
KITTY HAWK NC
27949-3300
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4720
  • Fax: 757-222-9296
Mailing address:
  • Phone: 240-247-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006764
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: