MEDICARE: COASTAL NEURO SPEECH SERVICES PLLC

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

General Provider Information

NPI Number	:	1457218752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL NEURO SPEECH SERVICES PLLC

Provider Business Mailing Address
First Line	:	1064 HAWTHORNE FARM TER
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-6586
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1064 HAWTHORNE FARM TER
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-6586
Country	:	US
Telephone Number	:	757-880-9057
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	SARAH STREETT
Credential	:
Telephone Number	:	757-880-9057

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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