Decola Custis, BSN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

0001309544 Issued in VA

Practice address

27457 Beacon Rd
Melfa, VA 23410-3367

Phone

(757) 709-4444

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Perfectly Made Lactation, LLC

  • Lactation Consultant (Registered Nurse)
  • Melfa, VA
  • NPI 1144017187

  Lactation Consultant

  NPD Authorized official

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1962235804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27457 BEACON RD",
            "city": "MELFA",
            "state": "VA",
            "postal_code": "234103367",
            "telephone_number": "757-709-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27457 BEACON RD",
            "city": "MELFA",
            "state": "VA",
            "postal_code": "234103367",
            "telephone_number": "757-709-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTIS",
        "first_name": "DECOLA",
        "credential": "BSN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "VA",
            "license": "0001309544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcia Carey, LCSW
• Eastern Shore Rural Health System Incorporated
• Madison Brooke Greer
• Melfa Volunteer Fire and Rescue Company Incorporated
• Fannie C Nottingham
• Patience, Love & Care, LLC

• All providers in Melfa, VA
• Lactation Consultant (Registered Nurse) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.