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General NPI Number Information
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NPI Number | 1306836424
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Entity Type | Individual
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Provider Name | LISSA CHERBAKA MS, CCC-A
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Gender | Female
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9501 FARRELL RD ATTN: AUDIOLOGY CLINIC
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5901
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Country | US
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Telephone | 703-806-4658
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Fax | 703-806-4648
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Provider Business Mailing Address
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Address Line | 8911 STEWART ST
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City | BURKE
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State | VA
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Zip | 22015-3658
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Country | US
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Telephone | 703-806-4658
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Fax | 703-806-4648
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201000652
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License Number State | VA
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