Healthcare Provider Details

I. General information

NPI: 1174272462
Provider Name (Legal Business Name): MCKAYLA R SEYMOUR DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 355
SUFFOLK VA
23434-8173
US

IV. Provider business mailing address

2790 GODWIN BLVD STE 355
SUFFOLK VA
23434-8173
US

V. Phone/Fax

Practice location:
  • Phone: 757-983-8520
  • Fax: 757-579-8643
Mailing address:
  • Phone: 757-983-8520
  • Fax: 757-579-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0103301456
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: