Provider Demographics
NPI:1134824014
Name:REYNOLDS, QUIANA S
Entity type:Individual
Prefix:
First Name:QUIANA
Middle Name:S
Last Name:REYNOLDS
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 1:961 CANAL DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4766
Mailing Address - Country:US
Mailing Address - Phone:757-714-0879
Mailing Address - Fax:
Practice Address - Street 1:961 CANAL DR UNIT D
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-4766
Practice Address - Country:US
Practice Address - Phone:757-714-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2024-04-12
Deactivation Date:2023-04-02
Deactivation Code:
Reactivation Date:2024-04-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care