Healthcare Provider Details

I. General information

NPI: 1871653980
Provider Name (Legal Business Name): MICHAEL LOUIS PACHUILO M.S., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 EDEN WAY N SUITE 111
CHESAPEAKE VA
23320-2776
US

IV. Provider business mailing address

6116 AUBURN LN
HAMPTON VA
23666-2442
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-3560
  • Fax: 757-547-5053
Mailing address:
  • Phone: 765-714-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number2201001325
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: