MEDICARE: DR. SUSAN LYNN TROYANOS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710101655	VA

General Provider Information

NPI Number	:	1467885954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN LYNN TROYANOS

Provider Business Mailing Address
First Line	:	2476 NIMMO PKWY
Second Line	:	115
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2545
Country	:	US
Telephone Number	:	757-685-7077
Fax Number	:	757-689-3422

Provider Business Practice Location Address
First Line	:	2476 NIMMO PKWY
Second Line	:	115
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2545
Country	:	US
Telephone Number	:	757-685-7077
Fax Number	:	757-689-3422

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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