Healthcare Provider Details

I. General information

NPI: 1588789663
Provider Name (Legal Business Name): TANIA SHERVON ADAMS SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIA SHERVON CARTER

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 SHENANDOAH AVE NW
ROANOKE VA
24017-4749
US

IV. Provider business mailing address

905 WINDING TRAIL LN
RICHMOND VA
23223-2289
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2860
  • Fax:
Mailing address:
  • Phone: 804-955-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004471
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: