Healthcare Provider Details

I. General information

NPI: 1770417016
Provider Name (Legal Business Name): GRACE ANASTASIA O'SHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21631 RIDGETOP CIR STE 225
STERLING VA
20166-4289
US

IV. Provider business mailing address

13429 BROKEN BRANCH CT
CHANTILLY VA
20151-2437
US

V. Phone/Fax

Practice location:
  • Phone: 571-207-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: