Healthcare Provider Details

I. General information

NPI: 1154679850
Provider Name (Legal Business Name): SHAUNA FREDRICKS SARGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8481 THAMES ST
SPRINGFIELD VA
22151-1519
US

IV. Provider business mailing address

989 BEACON RD
ROCKLEDGE FL
32955-3503
US

V. Phone/Fax

Practice location:
  • Phone: 719-359-2153
  • Fax:
Mailing address:
  • Phone: 321-536-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberMSSLP.0000002
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA11464
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012278
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: