MEDICARE: JEFFREY DEAR

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	2202005066	VA

General Provider Information

NPI Number	:	1598137911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DEAR

Provider Business Mailing Address
First Line	:	2033 GREY FOX LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5208
Country	:	US
Telephone Number	:	757-739-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 GREY FOX LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-5208
Country	:	US
Telephone Number	:	757-739-5588
Fax Number	:

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

Provider Enumeration Date	:	10/25/2015
Last Update Date	:	10/25/2015

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Directions to “ JEFFREY DEAR ” Practice Location

Language	Start Address	Practice Location

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