Provider Demographics
NPI:1083110597
Name:NEALY, TIFFANY (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:NEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:JEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:291 INDEPENDENCE BLVD STE 241
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5480
Mailing Address - Country:US
Mailing Address - Phone:757-335-6657
Mailing Address - Fax:757-351-4255
Practice Address - Street 1:291 INDEPENDENCE BLVD STE 241
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5480
Practice Address - Country:US
Practice Address - Phone:757-335-6657
Practice Address - Fax:757-351-4255
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101273658207Q00000X, 390200000X
NC238850207Q00000X
WI8378851207Q00000X
VA74981207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program