Provider Demographics
NPI:1609578814
Name:BEAMON, EVANGELA
Entity type:Individual
Prefix:
First Name:EVANGELA
Middle Name:
Last Name:BEAMON
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 1:404 S MAIN ST # B
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5428
Mailing Address - Country:US
Mailing Address - Phone:757-285-5840
Mailing Address - Fax:
Practice Address - Street 1:404 S MAIN ST # B
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5428
Practice Address - Country:US
Practice Address - Phone:757-285-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
233204251E00000X
VA14011431383747P1801X, 376K00000X
VA233204385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care