Provider Demographics
NPI:1669900643
Name:BAILEY, DYLAN PRIDDY
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:PRIDDY
Last Name:BAILEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 DISCOVERY PARK BLVD
Mailing Address - Street 2:BUILDING B, SUITE 104
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188
Mailing Address - Country:US
Mailing Address - Phone:757-206-1113
Mailing Address - Fax:
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:BUILDING B, SUITE 104
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-206-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN5500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant