Healthcare Provider Details

I. General information

NPI: 1912869751
Provider Name (Legal Business Name): MACKENZIE FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 CARRIAGE HILL RD STE 200
VIRGINIA BEACH VA
23452-6546
US

IV. Provider business mailing address

4641 LEE AVE
VIRGINIA BEACH VA
23455-1424
US

V. Phone/Fax

Practice location:
  • Phone: 757-263-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010695
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: