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General NPI Number Information
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NPI Number | 1780072215
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Entity Type | Organization
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Legal Business Name | BAYSIDE SPEECH THERAPY, INC.
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 468 INVESTORS PL SUITE 200
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1109
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Country | US
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Telephone | 757-552-0400
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Fax | 757-552-0401
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Provider Business Mailing Address
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Address Line | 468 INVESTORS PL SUITE 200
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1109
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Country | US
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Telephone | 757-552-0400
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Fax | 757-552-0401
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JULIA SYDNOR
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Credential | M.ED., CCC-SLP
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Telephone | 757-552-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202006232
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License Number State | VA
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