Healthcare Provider Details

I. General information

NPI: 1790565216
Provider Name (Legal Business Name): ADELAIDE ELIZABETH DWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5248 OLDE TOWNE RD STE 10
WILLIAMSBURG VA
23188-1986
US

IV. Provider business mailing address

5248 OLDE TOWNE RD STE 10
WILLIAMSBURG VA
23188-1986
US

V. Phone/Fax

Practice location:
  • Phone: 757-603-4603
  • Fax:
Mailing address:
  • Phone: 757-603-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: