Healthcare Provider Details

I. General information

NPI: 1639085129
Provider Name (Legal Business Name): PATHWAY FOR LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 S INDEPENDENCE BLVD STE 115
VIRGINIA BEACH VA
23452-1129
US

IV. Provider business mailing address

485 S INDEPENDENCE BLVD STE 115
VIRGINIA BEACH VA
23452-1129
US

V. Phone/Fax

Practice location:
  • Phone: 434-594-8778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAYVONYA G TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 434-594-8778