Healthcare Provider Details

I. General information

NPI: 1033359690
Provider Name (Legal Business Name): TARA CILIO-RHEA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA CILIO CCC-SLP

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 KEMPSRIVER DR STE 10
VIRGINIA BEACH VA
23464-5369
US

IV. Provider business mailing address

5300 KEMPSRIVER DR STE 10
VIRGINIA BEACH VA
23464-5369
US

V. Phone/Fax

Practice location:
  • Phone: 757-392-7161
  • Fax: 757-300-5589
Mailing address:
  • Phone: 757-392-7161
  • Fax: 757-300-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005671
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: