Healthcare Provider Details

I. General information

NPI: 1982947784
Provider Name (Legal Business Name): NICHOLAS LEE BANDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 GLENN MITCHELL DR STE 512
VIRGINIA BEACH VA
23456-0179
US

IV. Provider business mailing address

2075 GLENN MITCHELL DR STE 512
VIRGINIA BEACH VA
23456-0179
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-8850
  • Fax:
Mailing address:
  • Phone: 757-507-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM-2211
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberM-2211
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101265483
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101265483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: