MEDICARE: MS. LIZA CERISE NUNEZ M.S. CCC-SLP, TSSLD

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	017861	NY

General Provider Information

NPI Number	:	1619244316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIZA CERISE NUNEZ M.S. CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	210 FALCON CT
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23665-2539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MARCELLA RD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2554
Country	:	US
Telephone Number	:	757-825-4645
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	08/22/2019

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