Healthcare Provider Details

I. General information

NPI: 1730721523
Provider Name (Legal Business Name): MICHALIA AMONY HUMPHREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2019
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 SHORE DR STE 101
VIRGINIA BEACH VA
23455-2994
US

IV. Provider business mailing address

4360 SHORE DR STE 101
VIRGINIA BEACH VA
23455-2994
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-0879
  • Fax:
Mailing address:
  • Phone: 757-251-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: