Basic Information
| Provider Information | |||||||||
| NPI: | 1902320930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VICHINSKY | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36007 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232358000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Practice Location | |||||||||
| Address1: | 7485 RIGHT FLANK RD | ||||||||
| Address2: | STE 210 | ||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231163839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2017 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2201001662 | VA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.