Healthcare Provider Details

I. General information

NPI: 1912393794
Provider Name (Legal Business Name): ANNA S ORD PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA SERGEYEVNA SHIROKOVA

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 HILLTOP WEST EXECUTIVE CENTER SUITE 216
VIRGINIA BEACH VA
23451
US

IV. Provider business mailing address

1604 HILLTOP WEST EXECUTIVE CENTER SUITE 216
VIRGINIA BEACH VA
23451
US

V. Phone/Fax

Practice location:
  • Phone: 757-498-9585
  • Fax: 757-468-1685
Mailing address:
  • Phone: 757-498-9585
  • Fax: 757-468-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810005557
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: