| Bright Shadows Telepsychiatry Services, Pllc | |
|
4410 Claiborne Sq E Hampton VA 23666-2071 | |
| (252) 751-5103 | |
| (252) 751-5127 |
| Full Name | Bright Shadows Telepsychiatry Services, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4410 Claiborne Sq E, Hampton, Virginia |
| Authorized Official Name and Position | Rondeshya Keyonna Cosby (OWNER) |
| Authorized Official Contact | 2527515103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bright Shadows Telepsychiatry Services, Pllc Po Box 9244 Hampton VA 23670-0244 Ph: (252) 751-5103 | Bright Shadows Telepsychiatry Services, Pllc 4410 Claiborne Sq E Hampton VA 23666-2071 Ph: (252) 751-5103 |
| NPI Number | 1710743521 |
|---|---|
| Provider Enumeration Date | 02/28/2024 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Medicare PECOS PAC ID | 3971949751 |
|---|---|
| Medicare Enrollment ID | O20240315000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710743521 | NPI | - | NPPES |
| Provider Name | Rondeshya Cosby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184209777 PECOS PAC ID: 2567861412 Enrollment ID: I20210525002757 |
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