Healthcare Provider Details

I. General information

NPI: 1598692634
Provider Name (Legal Business Name): SHEA'S SPEECH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

7039 SAUVAGE LN
GAINESVILLE VA
20155-1674
US

IV. Provider business mailing address

7039 SAUVAGE LN
GAINESVILLE VA
20155-1674
US

V. Phone/Fax

Practice location:
  • Phone: 571-208-7607
  • Fax:
Mailing address:
  • Phone: 571-208-7607
  • 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: MADELINE SHEA MCGINNIS
Title or Position: SLP
Credential: CCC
Phone: 571-208-7607