Provider Demographics
NPI:1114544632
Name:SAYRE, KELSEY BRIDGET MAHONEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BRIDGET MAHONEY
Last Name:SAYRE
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 1:5332 MINERAL SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23438-9620
Mailing Address - Country:US
Mailing Address - Phone:757-615-3013
Mailing Address - Fax:
Practice Address - Street 1:3198 PACIFIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-2949
Practice Address - Country:US
Practice Address - Phone:757-428-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program