Basic Information
| Provider Information | |||||||||
| NPI: | 1679149348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWBY | ||||||||
| FirstName: | AKILIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 GATEWAY CT APT 206 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233205075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572542439 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6330 N CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235024008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574903009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | RBT | 01 | RBT-21-170066 | OTHER |