Healthcare Provider Details

I. General information

NPI: 1225546716
Provider Name (Legal Business Name): ASHLEY FAGUNDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 SAVILLE GARDEN WAY
VIRGINIA BEACH VA
23453-7032
US

IV. Provider business mailing address

2909 SAVILLE GARDEN WAY
VIRGINIA BEACH VA
23453-7032
US

V. Phone/Fax

Practice location:
  • Phone: 757-585-3544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000526
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00002922
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: