Healthcare Provider Details

I. General information

NPI: 1114291317
Provider Name (Legal Business Name): CHERYL L PRICE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CAMELOT DR STE 200
VIRGINIA BEACH VA
23454-2440
US

IV. Provider business mailing address

1950 GLENN MITCHELL DR STE 310
VIRGINIA BEACH VA
23456-0019
US

V. Phone/Fax

Practice location:
  • Phone: 757-491-7337
  • Fax: 757-351-2905
Mailing address:
  • Phone: 757-507-0402
  • Fax: 757-507-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003491
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: