Healthcare Provider Details

I. General information

NPI: 1275469728
Provider Name (Legal Business Name): DEVIN HARRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 VIRGINIA BEACH BLVD STE 220
VIRGINIA BEACH VA
23452-1297
US

IV. Provider business mailing address

2261 WILLOW OAK CIR APT 205
VIRGINIA BEACH VA
23451-6807
US

V. Phone/Fax

Practice location:
  • Phone: 757-257-1042
  • Fax:
Mailing address:
  • Phone: 252-333-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: