Provider Demographics
NPI:1275158792
Name:MCCULLOUGH, SAYWARD (NP)
Entity type:Individual
Prefix:
First Name:SAYWARD
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-0002
Mailing Address - Country:US
Mailing Address - Phone:757-908-3754
Mailing Address - Fax:757-767-7783
Practice Address - Street 1:400 N CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0002
Practice Address - Country:US
Practice Address - Phone:757-908-3754
Practice Address - Fax:757-767-7783
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177419363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health