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General NPI Number Information
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NPI Number | 1053017475
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Entity Type | Organization
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Legal Business Name | SUFFOLK UNITED, INC
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 301 GOODE WAY STE 102
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2266
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Country | US
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Telephone | 757-655-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 732 EDEN WAY N STE E104
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2798
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Country | US
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Telephone | 757-372-4407
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TAYLOR LAWRENCE
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Credential |
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Telephone | 757-372-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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