Healthcare Provider Details

I. General information

NPI: 1942085709
Provider Name (Legal Business Name): MS. EMILY ELIZABETH PEDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY ELIZABETH BISHOP

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 FIVE FORKS RD
VIRGINIA BEACH VA
23455-4321
US

IV. Provider business mailing address

1613 FIVE FORKS RD
VIRGINIA BEACH VA
23455-4321
US

V. Phone/Fax

Practice location:
  • Phone: 757-301-1743
  • Fax:
Mailing address:
  • Phone: 757-301-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number371750
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: