Provider Demographics
NPI:1760634133
Name:DUNLEAVY, AMY MICHELLE-HAYSLETT (MSED, ATC, EMT-B)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE-HAYSLETT
Last Name:DUNLEAVY
Suffix:
Gender:F
Credentials:MSED, ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 SEDLEY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6931
Mailing Address - Country:US
Mailing Address - Phone:757-963-7913
Mailing Address - Fax:757-233-8753
Practice Address - Street 1:902 SEDLEY RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6931
Practice Address - Country:US
Practice Address - Phone:757-963-7913
Practice Address - Fax:757-233-8753
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer