Healthcare Provider Details

I. General information

NPI: 1003620220
Provider Name (Legal Business Name): TIDEWATER ACUPUNCTURE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 W GREAT NECK RD STE 2244
VIRGINIA BEACH VA
23451-1506
US

IV. Provider business mailing address

2676 RIVER RD
VIRGINIA BEACH VA
23454-1223
US

V. Phone/Fax

Practice location:
  • Phone: 757-589-2880
  • Fax:
Mailing address:
  • Phone: 757-589-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SADLER
Title or Position: OWNER
Credential: LAC
Phone: 757-589-2880