MEDICARE: NANCY VALLEJO

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	12875	NC

General Provider Information

NPI Number	:	1982197596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY VALLEJO

Provider Business Mailing Address
First Line	:	900 ALEXAN DR APT 102
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-5938
Country	:	US
Telephone Number	:	772-678-9185
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CLYNELISH CLOSE
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-4933
Country	:	US
Telephone Number	:	919-542-7522
Fax Number	:

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

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	06/08/2018

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Directions to “ NANCY VALLEJO ” Practice Location

Language	Start Address	Practice Location

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