Basic Information
| Provider Information | |||||||||
| NPI: | 1760624191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUCCIO | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 OLD CHAIN BRIDGE RD STE 185 | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038668819 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3930 PENDER DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220300986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714320640 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2009 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2201000224 | VA | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 2101000549 | VA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.