Healthcare Provider Details

I. General information

NPI: 1225967615
Provider Name (Legal Business Name): BRENNA FAHY PRUNTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44081 PIPELINE PLZ STE 120
ASHBURN VA
20147-5892
US

IV. Provider business mailing address

224 PEPPERTREE LN APT 77
WINCHESTER VA
22601-3586
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-7270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: