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NPI Code Detail

MEDICARE: MR. ASHLEY OMAR ELLIS

MEDICARE: MR. ASHLEY OMAR ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1215872676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ASHLEY OMAR ELLIS
Provider Business Mailing Address
First Line : 1340 MYRICA PL
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-5144
Country : US
Telephone Number : 757-368-4100
Fax Number :
Provider Business Practice Location Address
First Line : 1881 UNIVERSITY DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23453-8001
Country : US
Telephone Number : 404-797-7901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2026
Last Update Date : 04/22/2026

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Directions to “ MR. ASHLEY OMAR ELLIS ” Practice Location

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