MEDICARE: MRS. VIVECA MELODY PANKEY MA, CCC-SLP

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	3393	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477697498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIVECA MELODY PANKEY MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1719 EMPRESS LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4747
Country	:	US
Telephone Number	:	910-551-4960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 EMPRESS LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4747
Country	:	US
Telephone Number	:	910-551-4960
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	09/08/2008

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Directions to “ MRS. VIVECA MELODY PANKEY MA, CCC-SLP” Practice Location

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