Basic Information
| Provider Information | |||||||||
| NPI: | 1922532092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARP | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | SHARP | ||||||||
| OtherFirstName: | TAYLOR | ||||||||
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| OtherCredential: | M.S. SLP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5604 VIRGINIA BEACH BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234625631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574555000 | ||||||||
| FaxNumber: | 7573194142 | ||||||||
| Practice Location | |||||||||
| Address1: | 629 PHOENIX DR | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234527392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574555000 | ||||||||
| FaxNumber: | 7573194142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2017 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202008366 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.