Healthcare Provider Details

I. General information

NPI: 1134579998
Provider Name (Legal Business Name): DELLYN RENEE MATTHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SENTARA CIR
WILLIAMSBURG VA
23188-5716
US

IV. Provider business mailing address

4053 TAYLOR RD SUITE N
CHESAPEAKE VA
23321-5537
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-3975
  • Fax: 757-510-9190
Mailing address:
  • Phone: 757-484-5900
  • Fax: 757-483-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024173623
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: