Active NPI
Saquan Pugh
- Nutritionist
- Henrico, VA
National Provider Identifier
1700766425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 5573647
- Practice address
- 4202 Gladewater Rd
Henrico, VA 23294-6014 - Phone
- (804) 540-2110
- NPI assigned
- Sep 4, 2025
- Last updated
- Sep 4, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 5573647 | VA | Primary |
Addresses
Primary practice location
4202 Gladewater Rd
Henrico, VA 23294-6014
Mailing address
4202 Gladewater Rd
Henrico, VA 23294-6014
Phone (804) 540-2110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5573647 | VA | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756944000000",
"number": "1700766425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4202 GLADEWATER RD",
"city": "HENRICO",
"state": "VA",
"postal_code": "232946014",
"telephone_number": "804-540-2110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4202 GLADEWATER RD",
"city": "HENRICO",
"state": "VA",
"postal_code": "232946014",
"telephone_number": "804-540-2110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUGH",
"first_name": "SAQUAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-09-04",
"last_updated": "2025-09-04",
"certification_date": "2025-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "VA",
"license": "5573647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henrico, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.