Healthcare Provider Details

I. General information

NPI: 1871409391
Provider Name (Legal Business Name): CEIRY NICOLL FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14715 BRISTOW RD
MANASSAS VA
20112-3945
US

IV. Provider business mailing address

75 DRIVER SQ
FRONT ROYAL VA
22630-7084
US

V. Phone/Fax

Practice location:
  • Phone: 703-791-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: