Healthcare Provider Details

I. General information

NPI: 1669319620
Provider Name (Legal Business Name): AMANDA VALDIVIA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 LAKE JAMES DR STE 200
VIRGINIA BEACH VA
23464-6780
US

IV. Provider business mailing address

536 ELDRIDGE LN
CHESAPEAKE VA
23323-6448
US

V. Phone/Fax

Practice location:
  • Phone: 757-523-0022
  • Fax:
Mailing address:
  • Phone: 757-523-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: