Healthcare Provider Details

I. General information

NPI: 1104743798
Provider Name (Legal Business Name): ANDREW MIKESH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 MANDACHRIS LN
TROY VA
22974-3661
US

IV. Provider business mailing address

53 MANDACHRIS LN
TROY VA
22974-3661
US

V. Phone/Fax

Practice location:
  • Phone: 434-989-8437
  • Fax:
Mailing address:
  • Phone: 434-989-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number202505315
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: