Healthcare Provider Details

I. General information

NPI: 1003720657
Provider Name (Legal Business Name): RAJA RICHMOND-SARGENT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 UNIVERSITY DR
VIRGINIA BEACH VA
23453-8083
US

IV. Provider business mailing address

1881 UNIVERSITY DR
VIRGINIA BEACH VA
23453-8083
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-4297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001322032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: