Healthcare Provider Details

I. General information

NPI: 1710870449
Provider Name (Legal Business Name): KENDAL ANN CAHILL BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 MACKENZIE BAY LN
VIRGINIA BEACH VA
23453-1958
US

IV. Provider business mailing address

3403 MACKENZIE BAY LN
VIRGINIA BEACH VA
23453-1958
US

V. Phone/Fax

Practice location:
  • Phone: 252-207-3312
  • Fax: 252-207-3312
Mailing address:
  • Phone: 252-207-3312
  • Fax: 252-207-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number096678064
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: