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General NPI Number Information
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NPI Number | 1174473433
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Entity Type | Organization
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Legal Business Name | FEDSERVE HAMPTON ROADS
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 901 HAMPTON BLVD STE 302
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City | NORFOLK
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State | VA
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Zip | 23507-1503
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Country | US
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Telephone | 301-841-5077
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Fax |
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Provider Business Mailing Address
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Address Line | 4789 CHEROKEE ST
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City | COLLEGE PARK
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State | MD
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Zip | 20740-1816
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Country | US
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Telephone | 301-841-5077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL ODUKOYA
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Credential |
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Telephone | 301-841-5077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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