Individual
TRACEY LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
600 GRESHAM DR STE 700, NORFOLK, VA 23507-1904
(757) 388-1700
(423) 826-1290
Mailing address
6275 E VIRGINIA BEACH BLVD STE 300, NORFOLK, VA 23502-2851
(757) 466-0089
(757) 466-8017
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009247
VA
363A00000X
Physician Assistant
031055
NY
363A00000X
Physician Assistant
58446
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356962211
—
CA
Enumeration date
05/01/2020
Last updated
04/20/2026
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