Individual
GABRIELLE DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44 BROAD STREET RD, MANAKIN SABOT, VA 23103-2213
(804) 784-7090
(804) 784-7090
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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