MEDICARE: MS. MARLAYNE LANEVE CASTELLUZZO SLP, M.ED

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	2202007709	VA

General Provider Information

NPI Number	:	1942703350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLAYNE LANEVE CASTELLUZZO SLP, M.ED

Provider Business Mailing Address
First Line	:	1110 BENNINGTON RD
Second Line	:
City	:	VA BEACH
State	:	VA
Zip	:	23464-3764
Country	:	US
Telephone Number	:	757-648-2280
Fax Number	:	757-366-4532

Provider Business Practice Location Address
First Line	:	1110 BENNINGTON RD
Second Line	:
City	:	VA BEACH
State	:	VA
Zip	:	23464-3764
Country	:	US
Telephone Number	:	757-648-2280
Fax Number	:	757-366-4532

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

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2018

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