Provider Demographics
NPI:1255189106
Name:BYRD, ROBBIN LOUISE
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:LOUISE
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 CENTERBROOKE LN SUITE F
Mailing Address - Street 2:UNIT 183
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-895-5885
Mailing Address - Fax:
Practice Address - Street 1:1024 CENTERBROOKE LN SUITE F
Practice Address - Street 2:UNIT 183
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-895-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB62610449342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company