Healthcare Provider Details

I. General information

NPI: 1265978605
Provider Name (Legal Business Name): FLAVIA GUSMAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21495 RIDGETOP CIR STE 202
STERLING VA
20166-6512
US

IV. Provider business mailing address

21495 RIDGETOP CIR
STERLING VA
20166-8520
US

V. Phone/Fax

Practice location:
  • Phone: 571-449-6281
  • Fax:
Mailing address:
  • Phone: 571-449-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: