MEDICARE: DEIDRA SLEDGE

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
1	1041C0700X	Clinical Social Worker	0904013369	VA

General Provider Information

NPI Number	:	1710642467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRA SLEDGE

Provider Business Mailing Address
First Line	:	9211 FOREST HILL AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6877
Country	:	US
Telephone Number	:	757-296-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	9211 FOREST HILL AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6877
Country	:	US
Telephone Number	:	757-296-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2021
Last Update Date	:	05/18/2022

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Directions to “ DEIDRA SLEDGE ” Practice Location

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