MEDICARE: MISS LIANA GLORIA ELYSEE SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202011149	VA

General Provider Information

NPI Number	:	1295472496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LIANA GLORIA ELYSEE SLP

Provider Business Mailing Address
First Line	:	800 E CITY HALL AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2723
Country	:	US
Telephone Number	:	757-670-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E CITY HALL AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2723
Country	:	US
Telephone Number	:	540-497-3245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	01/21/2026

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