Healthcare Provider Details

I. General information

NPI: 1104559111
Provider Name (Legal Business Name): OCEAN PSYCHIATRY AND NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 LYNNHAVEN PKWY STE 100
VIRGINIA BEACH VA
23452-7371
US

IV. Provider business mailing address

596 LYNNHAVEN PKWY STE 100
VIRGINIA BEACH VA
23452-7371
US

V. Phone/Fax

Practice location:
  • Phone: 757-802-4500
  • Fax: 757-226-9002
Mailing address:
  • Phone: 757-802-4500
  • Fax: 757-226-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBYN ROCHE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 813-431-6998