MEDICARE: DANA GOMEZ TANNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202009649	VA

General Provider Information

NPI Number	:	1154986644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA GOMEZ TANNER

Provider Business Mailing Address
First Line	:	3340 HOLLAND RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4826
Country	:	US
Telephone Number	:	757-648-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 HOLLAND RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4826
Country	:	US
Telephone Number	:	757-648-2640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	09/01/2024

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Directions to “ DANA GOMEZ TANNER ” Practice Location

Language	Start Address	Practice Location

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