DR. SUPAKUNYA EDMONSON (NPI# 1366420853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366420853 |
| Entity Type | Individual |
| Full Name | DR. SUPAKUNYA EDMONSON |
| Credential | D.O. |
| Practice Address |
Uss Enterprise Medical Dept Norfolk VA 23551-0001 |
| Mailing Address |
1714 Pompey St Virginia Beach VA 23464-6514 |
| Practice Telephone | 7574448632 |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2015-05-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | OS9620 | FL | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
0102201767 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | GROUP PTAN | C06778 | 01 |
| Street Address |
USS ENTERPRISE MEDICAL DEPT |
| City | NORFOLK |
| State | VA |
| Zip Code | 23551-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407820426 | Jeffery Wayne Paulson | Family Medicine | Fleet Forces Command, 1562 Mitscher Ave, Ste 250, Norfolk, VA 23551-0001 | 2006-02-15 |
| 1891775532 | Martin Lewis Snyder | Surgery | U.S.fleet Forces Command-command Surgeon, 1562 Mitscher Ave Suite 250, Norfolk, VA 23551-0001 | 2006-01-19 |
| 1871585448 | Tiffany A Jones | Dental Hygienist | Uss John F. Kennedy Cv-67, 1562 Mitscher Ave Suite 250, Norfolk, VA 23551-0001 | 2005-08-18 |
| 1831724061 | Steven Mitchell Hartzler | Physician Assistant | 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0001 | 2020-03-09 |
| 1194205716 | Caleb Swain | Student in an Organized Health Care Education/Training Program | 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0001 | 2018-08-14 |
| 1548757263 | Dylan Griffiths | Student in an Organized Health Care Education/Training Program | 1775 Forrestal Dr, Norfolk, VA 23551-0001 | 2018-04-18 |
| 1184129629 | Michael Uriah Hoerner | Student in an Organized Health Care Education/Training Program | Us Marine Corps Forces Command 1775 Forrestal Drive, Norfolk, VA 23551-0001 | 2018-03-27 |
| 1992208763 | Philippe Andrew Warren | Student in an Organized Health Care Education/Training Program | 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0001 | 2018-03-17 |
| 1780955534 | Christopher Halagarda | Dietitian, Registered | Us Marine Corps Forces Command, 1775 Forrestal Drive, Norfolk, VA 23551-0001 | 2012-01-25 |
| 1750945333 | Scott David Berkheimer | Student in an Organized Health Care Education/Training Program | 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0004 | 2019-04-29 |
| Find all providers in zip 23551 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811339237 | Sahawat Tantikittichaikul | Psychiatry & Neurology | 301 N 27th St Ste 12, Norfolk, NE 68701 | 2013-07-26 |
| 1588607089 | Susan Melinda Brown | Psychiatry & Neurology | 301 Riverview Ave Ste 202, Norfolk, VA 23510-1065 | 2006-06-13 |
| 1558793679 | Raymond Gerard Troiano | Psychiatry & Neurology | 600 Gresham Dr, Suite 8630, Sentara Medical Group Neurology, Norfolk, VA 23507-1904 | 2013-07-31 |
| 1881983278 | Bon Secours Depaul Medical Center Inc | Psychiatry & Neurology | 110 Kingsley Ln, Suite 411, Norfolk, VA 23505-4614 | 2011-04-06 |
| 1588806228 | Sara Khorasani | Psychiatry & Neurology | 2700 W Norfolk Ave, Norfolk, NE 68701-4438 | 2009-03-26 |
| 1336393701 | Ingrid Paola Loma-miller | Psychiatry & Neurology | 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 | 2008-11-11 |
| 1982865135 | Hua Wang | Psychiatry & Neurology | 600 Gresham Dr, Suite 8630, Norfolk, VA 23507-1904 | 2008-06-20 |
| 1932369980 | Steven Thomas Kanarek | Psychiatry & Neurology | 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 | 2008-06-12 |
| 1639361033 | Carmen Roxana Fuentes | Psychiatry & Neurology | 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 | 2007-08-10 |
| 1619043551 | Neurology Consultants of Tidewater, Pllc | Psychiatry & Neurology | 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 | 2006-11-24 |
| Find all providers in NORFOLK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.