=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487826756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINA CARDERELLI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2008
-----------------------------------------------------
Last Update Date | 03/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 ASHBY STREET HARDY COUNTY BOARD OF EDUCATION
-----------------------------------------------------
City | MOOREFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 26936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-530-2348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1044 BETSY ROSS COURT
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-421-9876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1663
-----------------------------------------------------
License Number State |
-----------------------------------------------------