Provider Demographics
NPI:1306599469
Name:MEYERS, MINDI ILENE (LSA, CSFA, CST)
Entity type:Individual
Prefix:
First Name:MINDI
Middle Name:ILENE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LSA, CSFA, CST
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3312 FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4414
Mailing Address - Country:US
Mailing Address - Phone:865-384-6242
Mailing Address - Fax:
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-594-3050
Practice Address - Fax:804-594-3058
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0136000304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery