Healthcare Provider Details

I. General information

NPI: 1235953431
Provider Name (Legal Business Name): SARAH CHRISTINE GUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LONDON BLVD
PORTSMOUTH VA
23704-2236
US

IV. Provider business mailing address

1210 BROOK MEADOW DR
TOWSON MD
21286-1751
US

V. Phone/Fax

Practice location:
  • Phone: 757-393-6864
  • Fax:
Mailing address:
  • Phone: 410-952-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11062
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30003223
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202011697
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: