Healthcare Provider Details

I. General information

NPI: 1881030633
Provider Name (Legal Business Name): CHERYL C. SALE CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 PRIMROSE LN
ROCKVILLE VA
23146-1745
US

IV. Provider business mailing address

11501 PRIMROSE LN
ROCKVILLE VA
23146-1745
US

V. Phone/Fax

Practice location:
  • Phone: 804-201-7402
  • Fax:
Mailing address:
  • Phone: 804-201-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201000347
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: