Healthcare Provider Details

I. General information

NPI: 1588354641
Provider Name (Legal Business Name): YASNELI LLEO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21630 RIDGETOP CIR STE 100
STERLING VA
20166-6564
US

IV. Provider business mailing address

2163 EVANS CT APT 103
FALLS CHURCH VA
22043-2143
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001124
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202011324
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: