Provider Demographics
NPI:1912393794
Name:ORD, ANNA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:S
Last Name:ORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:SERGEYEVNA
Other - Last Name:SHIROKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 HILLTOP WEST EXECUTIVE CENTER
Mailing Address - Street 2:SUITE 216
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451
Mailing Address - Country:US
Mailing Address - Phone:757-498-9585
Mailing Address - Fax:757-468-1685
Practice Address - Street 1:1604 HILLTOP WEST EXECUTIVE CENTER
Practice Address - Street 2:SUITE 216
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451
Practice Address - Country:US
Practice Address - Phone:757-498-9585
Practice Address - Fax:757-468-1685
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005557103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist