Healthcare Provider Details

I. General information

NPI: 1710770243
Provider Name (Legal Business Name): JULIA PLISKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 S INDEPENDENCE BLVD STE 1
VIRGINIA BEACH VA
23453-4773
US

IV. Provider business mailing address

9566 SHORE DR
NORFOLK VA
23518-1725
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-7272
  • Fax:
Mailing address:
  • Phone: 570-885-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: