Bright Shadows Telepsychiatry Services, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BRIGHT SHADOWS TELEPSYCHIATRY SERVICES, PLLC

Practice address

4410 Claiborne SQ E
Hampton, VA 23666-2071

Phone

(252) 751-5103

Fax

(252) 751-5127

NPI assigned

Feb 28, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rondeshya Keyonna Cosby, NPNPI 1184209777

Title

Owner

Phone

(252) 751-5103

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

Enrollment records 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rondeshya Keyonna Cosby, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hampton, VA
  • NPI 1184209777

  NC

  Medicare reassignment Authorized official
• Keisha Dawkins, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Newport News, VA
  • NPI 1245027077
  Medicare reassignment NPD
• Bryanna McKinnon, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Gastonia, NC
  • NPI 1851134027
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1710743521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9244",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236700244",
            "telephone_number": "252-751-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 CLAIBORNE SQ E",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662071",
            "telephone_number": "252-751-5103",
            "fax_number": "252-751-5127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 Saint George Square Ct",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031356",
            "country_code": "US",
            "telephone_number": "252-751-5103",
            "fax_number": "252-751-5127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRIGHT SHADOWS TELEPSYCHIATRY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-28",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "COSBY",
        "authorized_official_first_name": "RONDESHYA",
        "authorized_official_middle_name": "KEYONNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-751-5103",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Hampton, VA
• Providers in Hampton, VA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.